Tag Archives: mindfulness

For Back Pain, Try Non-Drug Measures First

Back pain is the most common kind of chronic pain. It’s also a near-ubiquitous form of acute, short-lived pain after a minor injury, a bit too much exercise, lifting something the wrong way, a stressful day at the computer or an encounter with a bad bed.

In one survey, a quarter of adults reported having low back pain lasting at least one day in the past 3 months. But over the long term, we all fall victim.

For decades, the prevalent response to a bout of back pain — acute or chronic — was to reach for the pill bottle. Over-the-counter pain relievers mostly, like Advil (ibuprofen), Aleve (naproxen) or Tylenol (acetaminophen).

But in recent years, more and more people with back pain have been prescribed opioid painkillers. At the same time, doctors have sharply escalated their use of CT and MRI scans for people with back pain. A 2013 study of back pain treatment in JAMA Internal Medicine, for example, found that between 1999 and 2010 prescriptions for powerful narcotic pain meds increased by 51%, the use of CT and MRI scans jumped by 57%, and referrals to surgeons, neurologists and other specialists more than doubled.

As a result, public health authorities, physician groups and pain management experts are taking serious aim at the overuse of narcotic painkillers and imaging tests in people with back pain.

Non-Drug Measures for Back Pain Relief

New treatment guidelines strongly recommend that people with back pain first try non-drug measures such as yoga, physical therapy, chiropractic and massage before resorting to over-the-counter or prescription pain relievers.

The guidelines come from a team of experts convened by the American College of Physicians. They were published in February in the Annals of Internal Medicine. The expert group — comprised of leading back pain specialists and front-line docs — evaluated 46 recent studies on back pain and medications and 114 studies of non-drug approaches.

In addition to the above-mentioned interventions, the group recommended first trying the following before resorting to drugs: exercise, tai chi, acupuncture, mindfulness-based stress reduction, progressive relaxation, biofeedback and cognitive behavioral therapy.

Importantly, the researchers found no evidence that any of these techniques is better than any other; it’s a matter of personal preference and what works for your pain and in your life.

New guidelines call for trying alternative methods such exercise, acupuncture, yoga, tai chi and mindfulness stress reduction to reduce pain before resorting to drugs.

What If Alternative Methods Don’t Provide Enough Relief?

If the source of the pain is an acute injury (that is, it’s of sudden onset and has lasted less than a few weeks), try an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) first. Ibuprofen works as well as the others for most people, and is inexpensive. Naproxen is another alternative.

If the pain is particularly bad — preventing you from working, sleeping or functioning normally — you can also try a muscle relaxant. But limit the use of it to a week at most. Muscle relaxants like Flexeril cause drowsiness and sedation and can be habit forming.

Based on the latest research, the group concluded that acetaminophen is not effective for acute back pain, especially if the pain is related to an injury that causes inflammation. Unlike the NSAID drugs, acetaminophen does not reduce inflammation.

The expert guidelines also advise against steroid injections, citing the lack of evidence that this approach is helpful.

Try NSAIDs First If Non-Drug Techniques Fail

If you have chronic back pain and non-drug techniques don’t provide relief within a week or two, the guidelines recommend NSAIDs as the first-line therapy. If they don’t do the job, talk with your doctor about tramadol, Cymbalta (duloxetine) or a muscle relaxant.

Tramadol is a low-strength opioid with less risk of side effects, abuse and addiction. Duloxetine is an antidepressant proven effective against some kinds of pain.

About other, stronger opioids, the new guidelines say: “Clinicians should only consider opioids as an option in patients who have failed [other] treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

Indeed, the back pain experts emphasize that opioids have not been shown to relieve chronic back pain over the long term without significant risk. Namely, too many people end up taking higher doses to get the same pain relief. As a result, they put themselves at higher risk of addiction and its well-known adverse consequences.

A recent meta-analysis in JAMA Internal Medicine that included 20 trials involving 7,300 patients found that opioids didn’t provide significant relief for people with chronic back pain. Further, half the participants dropped out early because the medication didn’t work or the side effects were intolerable.

In contrast, a survey of 3,562 adults by Consumer Reports found that almost 90% of people who tried yoga or tai chi said these practices were helpful against back pain, and about 80% said the same of massage and chiropractic. Even so, about a third of respondents said they took prescription drugs for their back pain, and of those, 57% were prescribed opioids at some point.

“Many physicians who are used to writing prescriptions right off the bat or sending patients for tests are going to have to rethink the way they manage back pain,” says Nitin S. Damle, M.D., former president of the American College of Physicians.

Consumer Reports’ June 2017 cover story is on back pain and draws on the new guidelines, its survey and recent research.

Among the tips from the ACP guidelines and Consumer Reports:

Avoid bed rest; that’s outdated medical advice. Gentle activity such as walking and light stretching, and generally staying active, is more helpful.

You don’t need to see a doctor if your back injury is minor. The vast majority of injuries and tweaks of the back heal on their own. But be patient. It may take a week or 2 or even 3 in some cases. If the pain worsens over time or fails to ease, do see a doctor.

If your pain is radiating down one leg, see a doctor. This can indicate that a nerve is involved.

Be judicious with how much ibuprofen and naproxen you take. Don’t exceed 1,600 milligrams (8 200mg pills) of ibuprofen a day or 1,000mg of naproxen a day. Limit use of both to 7 days. They both carry risks if taken at high doses for long periods.

Personalize your treatment plan. Everyone responds to pain differently, and there’s no set strategy for treating back pain that works for everyone.

✔ The National Center for Complementary and Integrative Health, or NCCIH, can recommend a practitioner. The UCLA Mindful Awareness Research Center offers free online mindfulness and relaxation programs. And if you decide to try acupuncture, check that your practitioner is certified by the National Certification Commission for Acupuncture and Oriental Medicine.

Episode 13: The Best Way to Handle Holiday Stress

Put down the Xanax. This week, MedShadow Founder Su Robotti and Content Manager Jonathan Block talk about using easy forms of meditation to manage stress during the holidays.

Su Robotti: Hello and welcome to MedShatowTV. My name is Sue Robotti, and I’m the founder of MedShadow.

Jonathan Block: And I’m Jonathan Block. I’m the content manager for MedShadow.

SR: Today, we’re going to talk to you about stress. We’ve been feeling a lot of stress. The holidays are coming, and stress is caused by too much food, too many relatives, too much pressure, too much gift shopping, too much drinking.


The key here is too much. Today, we want to help you take it down a notch, calm down, and we want to help you do that through meditation.

First of all, what is stress? The physical response to a stressful situation is adrenalin and cortisol enter your bloodstream. It increases your blood pressure, and your heart rate starts to go stronger. And if this isn’t dealt with easily or quickly, and it continues for a period of time, it can lead to gastrointestinal problems. It can lead to heart disease. It can lead to brain dysfunction like I’m having now. It can lead to a lot of long-term issues with heart disease and gastrointestinal problems among other things.

But Jonathan, what do you suggest we do? Should we pop a pill? That would be very quick.

JB: Absolutely, don’t. You’ve actually alluded to it, and that was through meditation, which is the main part of an idea known as mindfulness, which is defined as being aware of the present. I mean, I know what a lot of people are thinking — the same thing that I was thinking when I heard the word mindfulness. That just sounds like a whole bunch of new age hooey.

SR: Hooey?

JB: Hooey.

SR: Okay.

JB: I’m going old school. I can tell you from a personal experience as somebody who’s dealt with stress, and anxiety, and depression. Meditation associated with mindfulness actually does work. It works well.

And why don’t you take a pill? Because pills have side effects.

Mindfulness meditation — and we’ll be discussing this in a little bit — there are clinical studies that have demonstrated that mindfulness meditation can be used for a number of different conditions avoiding these sort of drugs, which as our MedShadow audience knows, most of which — if not all — are associated with side effects, drug interactions, or other nasty effects.

SR: In fact, is meditation as effective as antidepressants?

JB: Yes, it is. There’s been, I want to say, 40 to 50 clinical studies done just on comparing mindfulness and meditation with antidepressants. They’ve all come to the same conclusion. Mindfulness meditation is as effective as antidepressants.

So why — I know what you’re going to say. I’m going to read your thoughts. But why not just take a pill, right?

SR: Why not?

JB: I know that’s the easy way to go out. The thing is is that as I just mentioned, antidepressants and other antianxiety pills like the Xanax or the Valium that some people in our audience may be taking, have taken, or thinking about taking.

Mindfulness meditation is something that you can teach your brain how to think. It helps you relax without the use of drugs, and therefore you can learn how to deal with stress and anxiety over the long term. It’s actually much better for you, because you’ll actually train your brain how to better handle stress and anxiety but without the nasty side effects of a pill which means it is harder work.

But in the long term, the long-term efficacy of it has been demonstrated whereas with antidepressants, we know that people develop problems, and they lose their efficacy. And for some people taking antidepressants and anti-anxiolytic drugs, they just aren’t even effective anymore.

SR: So let’s take a breath.

JB: Yes.

SR: And how do you meditate? Do you have to sit cross legged? Do you have to hold your fingers in the air? Do you have to say, “Ohmm”?

JB: No, you’re thinking of some of the Buddhist meditation. But this type of meditation like the meditation that pretty much busy people or people that don’t want to go, “Ohmm,” want to do — can take as little as 10 minutes.

That’s what I do a day. I only do 10 minutes. I do some breathing exercises. There are also ways which if you learn more about mindfulness and we’ll provide you with some information about that in a second — the mindfulness, actually, you train your brain to relax. I know this sounds weird, because I didn’t believe it until I started doing it. And then in the words of a great Monkees song, “I’m a Believer,” and I’m a believer now about how effective mindfulness is and how effective mindfulness meditation is as well.

SR: So do you take classes? How do you learn to do this?

JB: I do a combination of things. I have read some books. There’s an excellent website that is operated by the fine people at UCLA known as the UCLA Mindfulness Awareness Research Center. That address is http://marc.ucla.edu. They actually have free relatively short meditations that you can download and listen to, and you can start on your own.

There’s another resource that I use a lot. This is a paid resource. It’s an app, and you can also do on your computer called Headspace. But I pay — I find it particularly effective. I looked at a lot of them, and I find Headspace — just to let the audience know, neither Headspace nor UCLA has asked us to mention them. This is just from my own personal experience.

SR: And then I’ll add one that’s free that I use; it’s called Breathe. But there are many, and you’ll find the one that you like if you just Google guided meditations, and you’ll find it.

I started meditating by simply becoming quiet and not using guided meditation — just setting a timer and trying to still my thoughts calmly for 3 minutes at a time. I got up to 5 minutes. And honestly, guided meditation is much easier.

JB: Oh, yes.

SR: And I would like to graduate to regular quiet meditation. But for now, I’m finding that I become more calm and happy using the guided meditation.

JB: And if you’re a novice — I still consider myself a novice — I find that the guided meditation works a lot better.

Just one other point because I know we’re talking a lot about this. It’s that mindfulness meditation is actually good not only for — works well, I should say — works not only well for depression, anxiety, and stress, but it’s been shown that people that want to lose weight through practice of mindfulness meditation, they can actually teach themselves to eat less.

SR: Eat less during meditation?

JB: No, afterwards, because they train their brain.

SR: You mean through their mindfulness.

JB: Right, because they think — like they ‘think before.’ You’ve heard the term, “Think before you act.”

SR: Uh-hum.

JB: You teach yourself how to think before you eat, and you’re more careful at what you eat. But just by taking a few — by doing 10 minutes of meditation every day and then when you go and decide to have your meal, people who have done meditation and mindfulness, they train their brain to think, “Maybe I don’t need that side of French fries. Maybe I should get a side of quinoa or something of that nature, something of a more healthy starch.”

SR: Yes. My downfall is more of when I’m in a family situation, and there’s cheese, and crackers, and nuts, and all these good stuff in front of me, and I find I’m eating without thinking. I think you’re going to tell me that that’s not mindful.

JB: It’s not mindful, but everybody is allowed during the holidays to cheat a little bit. The thing is not to make it a regular part of your life. And even if you just have a few — if you — let’s say you cut out — maybe you only eat nuts, but instead of reaching for the Ferrero Rocher chocolate, maybe in parties you might have had 3. Now, maybe you’ll only have 1. That’s even mindfulness just like making even a slight change. And then as you get better and better at mindfulness and meditation, you’ll learn to control yourself better.

SR: Okay. So instead of taking a pill, instead of eating chocolate, instead of taking a long hot soak in the tub, what we’re going to do is try meditating to de-stress.

JB: Actually, taking a long hot soak in the tub is actually very good.

SR: Soak in the tub — we’re saying yes to this.

JB: We are saying yes to that.

SR: What about taking a walk or a jog?

JB: Also excellent.

SR: Okay.

JB: Just lose the medications and go easy on the chocolate.

SR: Okay. Do that and have a great holiday.

JB: Yes. From all of us here at MedShadow, thank you for making MedShadowTV, which just premiered this year, such a wonderful success, and a happy holidays to you and your family. Take care.

How Meditation Helps My Patients Heal

By Jamie Zimmerman, MD
Doctors. When you think of them, what comes to mind? Stethoscopes, white coats, pills?  What if there were a new kind of doctor? One who prescribes meditation, yoga, and other contemplative practices, rather than (or in addition to) doling out medication? More and more doctors are taking an integrative approach in their practices, offering patients alternative therapies to address a multitude of health problems. Here’s how meditation has helped my patients and suggestions on how it might help you.

The words meditation and medication sound suspiciously similar, and this is no coincidence.  These words, along with the term medicine, come from the same Latin root, mederi, which means “to heal.”  So, although many people think of meditation as an Eastern tradition, with  roots in Vedic, Hindu, or Buddhist practices, it seems as though the ancient Romans also recognized the healing powers of this introspective practice. Indeed, Catholicism’s rosary beads come from the same root as the beaded necklace or mala many Hindu or Buddhist practitioners carry, and the idea is the same:  Repeating the same holy words again and again is thought to infuse the mind with their spiritual essence. Modern science has developed and substantiated the idea of neuroplasticity, or the ability of the brain to change and reshape itself through the lifespan. This understanding lends a secular twist to these ancient, sacred chanting practices.

Jame Zimmerman at TEDxBushwick, March 21, 2015

Nearly every culture around the world has developed some silent and/or introspective practice.  Vision quests among indigenous Americans, centering prayer in the Christian faith, yogic postures, breathing exercises, chanting and silent meditation in Hindu traditions, and of course the sitting, walking and other meditations in Buddhism permeate communities around the globe. If the Latin language assumes these practices hold a healing quality, what exactly is the healing potential of meditation, and how can it be harnessed?

As a physician expert on “meditation medicine,” one who lectures and writes widely on this topic, I’d love to answer this question with a personal story. Currently, I work with several clients for whom I prescribe meditation. About a year ago, I met Linda (name and some life details changed to protect her identity). She had recently gone through a breakup and was living in the US, far from her family in Canada.  In the months before we met, Linda started experiencing severe anxiety, which grew so strong she was unable to ride the subway in New York City, as the crowds would spark panic attacks. This anxiety often kept her up at night. Linda also found herself crying uncontrollably at times, and she had less motivation to go to her graduate school classes and cancelled most of her social engagements.

Before seeing me, she had seen a psychiatrist who prescribed a medication commonly used to treat both anxiety and depression. This medication takes some time to take root, however, and also only works for about one-third of patients. During our first session, I carefully listened to Linda’s history, asking clarifying questions like any health care practitioner. It was clear that Linda had many external circumstances that added to her anxiety and sadness, which were now interfering with her work and quality of life.

Linda’s nervous system had clearly hit a bump in the road. I decided to teach Linda the “relaxation response,” a standardized technique based on transcendental meditation. During my first session with Linda, I guided her through the relaxation response meditation, and offered instructions on how to begin a twice-daily meditation practice. In the first week, Linda experienced less anxiety and began to sleep better. By the end of the second week, she noticed her sadness had begun to fade. Of course, some of this could be attributed to time, or the effects of the medications her psychiatrist prescribed. However, over time, Linda was able to work with her psychiatrist to taper off the medication and still feel fine, as long as she maintained her regular meditation practice.

When Marcus had difficulty sleeping after a cancer diagnosis, the relaxation response was also beneficial. Just like with pills, however, different meditations help with various ailments. When Virginia faced relationship difficulties, and felt overwhelmed by her growing resentment and emotional tension, compassion meditations helped her rewire her brain to feel greater empathy for her partner and also treat herself more kindly.

Of course individual patient stories aren’t randomized trials, and there are many variables at play that could also factor into Linda’s recovery, Marcus’ ability to rest and Virginia’s increased empathy and ease. However, each did improve rapidly after beginning a meditation practice, and many peer-reviewed studies support the role of meditation, including the relaxation response, in treating depression and anxiety, improving sleep, and building compassion. Unlike medications, these practices have essentially no gnarly side effects.

Harvard cardiologist Herbert Benson, MD, became a proponent of meditation after he was approached repeatedly by practitioners of transcendental meditation who claimed their practice had profound health benefits. After numerous requests, Dr. Benson finally acquiesced, but insisted upon replacing the Sanskrit mantras (meaningless sounds that people repeat during this practice) with the bland word “one.”

He then studied the effects on his patients, many of whom had high blood pressure, and was floored by the results. Time after time, he saw that his patients’ heart rates and blood pressure dropped, their breathing rate slowed down, and their brain needed less energy — these were all signs they were experiencing the “relaxation response,” the opposite of the body’s fight or flight stress response. Dr. Benson began to ask some patients to practice this technique regularly and, one by one, many of them were able to reduce or eliminate their blood pressure prescriptions and other medications. Dr. Benson and his Harvard colleagues have published numerous studies on the benefits of meditation in leading journals, which can be found at this site: http://www.relaxationresponse.org/. Dr. Benson’s New York Times best-selling book The Relaxation Response is one of the first efforts to systematically study meditation. Convinced of meditation’s benefits, Dr. Benson meditates twice a day and has seen his health improve.

If you’d like to test drive the relaxation response meditation yourself, visit my website, www.jamiez.tv, and click “free meditations” to download a 10-minute guided relaxation response meditation. There are many different types of meditation teachers; if you’re interested in finding a course near you, this website may help: http://www.mindful.org/resources/

These days, I’m grateful to share meditation medicine with audiences, individual clients and readers internationally. My hope is that Western medicine will embrace a future dedicated to building, restoring and promoting health, rather than merely treating disease, and I believe contemplative practices will play a large role in this endeavor.

Jamie Zimmerman, MD, a physician, meditation teacher and author, died in an accident in October 2015. She lectured internationally on “meditation medicine” and living your calling. A meditator since age 16, she studied with many of today’s leading instructors and was featured on ABC.com, Yahoo News, MindBodyGreen, Yoga Journal, SONIMA, and Huffington Post Live. She was a health and wellness reporter at ABC National News, where she taught her colleagues to meditate and hosted a digital series called “Make Your Passion Your Paycheck.”

Therapy, Meditation, Sleep and Exercise Can Help Lessen Anxiety

When Lisa Jones was in college, her once-manageable anxiety became overwhelming.“I was having three or four panic attacks a day,” she says. “My hands were shaking. I felt I needed to run and hide. I would hyperventilate sometimes to the point of blacking out. I knew I needed help.”

Lisa’s doctor referred her to Frances P. Thorndike, PhD, an Assistant Professor in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia Health System, in Charlottesville, who also has a private practice. Lisa’s doctor had prescribed medication, and Thorndike recommended that she also start a program of Cognitive Behavioral Therapy (CBT), a technique that gives patients tools to control their own anxiety. Lisa also began meditating, starting with 10 minutes a day, on her own.

Lisa very quickly started to see results. “Even though the treatment didn’t immediately cut down the number of panic attacks, I felt better,” she says. “I felt like I had control, and I didn’t have to let the panic attack take over my life.”

Lisa, who wasn’t opposed to medication, decided to hold off and try the therapy alone first. Still, knowing the medication was available gave her comfort. “It was helpful to know that it was OK to take it if I needed it,” she says. There is ample evidence that techniques including CBT, meditation, sleep strategies and exercise can help people with anxiety disorder. People who try these techniques may still need medication, however, to manage extreme symptoms, help get them through the first stages of therapy, or, like Lisa, to keep on the shelf for a “break-glass-in-case-of-emergency moment.”

CBT: Tools for Living

Many studies show that Cognitive Behavioral Therapy (CBT) can teach people with anxiety disorder to manage their condition. Recently, a November 2013 study, published in Behavior Research and Therapy, tracked 361 people with panic disorder as they completed an 11-session course of CBT. The study showed “strong evidence” that CBT reduced panic symptoms. “Medications for anxiety disorder can certainly be helpful,” explains Thorndike. “But CBT actually changes thought patterns and behaviors that cause anxiety and keep it going.”

If you choose this type of therapy you will learn techniques to cope with your situation and feelings, and those techniques will be tailored to your unique situation, Thorndike says. You will learn techniques to deal with anxiety, including relaxation and deep breathing, as well as cognitive tools – things you can say to yourself to challenge and control your fears. Eventually, you will practice using these techniques when exposed to your trigger, the situation that produces anxiety. “We start gradually,” Thorndike says. For example, if someone is afraid of dogs, “we may start by looking at pictures of dogs, and then going to a park and watching them from a distance,” she says.

To find a therapist who practices CBT ask your doctor or the Therapist Directory of the ADAA. While one-to-one therapy is ideal, you can also try to learn some of these techniques on your own. Thorndike recommends starting with The Anxiety and Phobia Workbook by Edmund J. Bourne (New Harbinger Publications, 2011). In addition, a review in the January 2014 issue of Current Opinion in Psychiatry found that “recent studies have confirmed the utility of computerized psychotherapy for anxiety” although more research is needed. If you want to try an online program, Thorndike recommends you use Beacon 2.0, to search for the right program.

Mindfulness Meditation: Living in the Moment

Another technique that has been proven to control anxiety is mindfulness meditation. This is a type of meditation that teaches you to be aware of the present moment—your thoughts, emotions, and sensations—with an attitude of acceptance.

Elizabeth Hoge, MD, an Assistant Professor of Psychiatry at Harvard Medical School in Boston, is a psychiatrist with a specialty in anxiety disorders. Her study on mindfulness meditation was published in the August 2013 issue of the Journal of Clinical Psychiatry (view a summary here). For this study, 93 people were asked about their symptoms and put through a stress test both before and after training. Half had training in mindfulness meditation, and half attended an education class. Those who learned to meditate had less stress on the second test than those who didn’t, says Dr. Hoge, who is also affiliated with the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital.

Why does meditation help? “Mindfulness meditation starts with a practice of focusing on your breath,” says Dr. Hoge. “As your thoughts arise, you are taught to just notice them there, like a cloud passing in the sky, and not react to them.” With practice, people with anxiety disorder can use these techniques to control their reactions to negative thoughts in daily life.

While any form of meditation will help, she says, her research study used mindfulness meditation, which is derived from Vipassana or Insight, meditation. You can find information on Insight meditation at the website of the Insight Meditation Society, www.dharma.org. There are also many books on meditation technique, including Wherever You Go, There You Are by Jon Kabat-Zinn (Hyperion, 2005).

Get Your Rest

Sleep and anxiety are intertwined, says Thorndike. “People who are anxious may struggle with falling asleep or wake up during the night,” she says. Being overtired can make people more prone to anxiety and less able to cope with its symptoms as well, she adds.

Try some simple steps to improve your sleep at night. “Your bed should be saved only for sleep or sex,” she says. “If you are awake for more than 15 or 20 minutes, leave the room. Don’t lie in bed and worry.”

It is also important to keep screens, phones, and TV out of the bedroom, maintain consistent bed and wake times, avoid caffeine in the afternoon and avoid exercising late in the evening. If you want help doing this, consider trying an online program. A 2013 study in the Journal of Clinical Psychology, co-authored by Thorndike, found that adults using an online sleep program saw improvements in both sleep and anxiety. Thorndike has helped develop one called SHUTi.

Get Moving

Exercise can help as well, Thorndike says. Researchers at Princeton University recently found that mice who exercised were calmer than those who were more sedentary — and had developed more new brain cells as well. Even if you are out of shape, “start wherever you can, depending on your fitness level,” Thorndike says. “It is only important to do it regularly and consistently.” Eventually, try to build to a program of exercise of at least 30 minutes 3 times weekly.

For Lisa, a little more than a year of therapy gave her the tools she needs to manage her anxiety daily. Today, she meditates daily, practices yoga, and uses the skills she learned from Thorndike. “I still get the symptoms of panic attacks,” she says. “I still have all the same triggers. But when I feel the attack coming on, I can use these tools to squash it.“

Ellen Wlody is a writer who specializes in health and parenting topics. She lives in upstate New York with her husband, children, and two dogs.