Skip to main content

Fibromyalgia and Chiropractic Care

Dr. Heather King DC and Sonja Hintz, RN, Serenity Health Care Center S.C.

Are you suffering with fibromyalgia? According to NIH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, “Fibromyalgia syndrome is a common and chronic disorder characterized by widespread pain, diffuse tenderness, and a number of other symptoms.”

In my practice, I find that many fibromyalgia patients suffer from persistent backaches, neck pain, headaches, leg cramps, leg and foot pain. But you can get relief! Chiropractic care can help reduce and even in some cases alleviate persistent symptoms.

In a 2006 study of 20 female patients with fibromyalgia that suffered from high pain levels, sleep disturbances and reduced actives of daily living were treated with ultrasound and chiropractic adjustments for up to 20 sessions. The conclusions showed that the symptoms felt by the patients were dramatically reduced. 1.

Chiropractic treatment can help assist with many of symptoms that patients with fibromyalgia are feeling. Improves function not only through adjustments but also by incorporating therapies such as ultrasound, exercise and massage to their treatment program. These patients are being helped to live their lives to the fullest potential. When treating fibromyalgia the goal is to improve quality of life and help reduce the overall effect on the body.

Chiropractic is a natural approach to treating the body through the use of spinal adjustments to remove fixations of joints. Chiropractors adjust the spinal column but misalignments can occur throughout the body, which can affect the nerves, muscle and organs. By adjusting the fixations and removing nerve interference the goal is to reduce the pain, inflammation and muscles spasm to allow the body to function as optimally as possible. Although there is no known cure for fibromyalgia, there are treatments available that can help improve symptoms and quality of life.

Chiropractic can be used in conjunction of other forms of treatment, such as:

  • Nutritional supplementation can assist in the treatment of many of the painful symptoms of fibromyalgia. The nutrient MSM (methylsulfonylmethane) is a naturally occurring sulfur compound found in humans that inhibits pain impulses due to anti-inflammatory properties. This supplement can be added to assist in decreasing the impacts of pain by reducing inflammation. It’s widely used as a supplement for arthritic conditions and pain.
  • Sulfur is needed for proper cellular function. Patients may want to consider using supplemental sulfur sources such as MSM include those who have chronic inflammatory conditions like fibromyalgia and arthritis.

If you would like to schedule a chiropractic consultation, call Serenity Health Care Center at 262-522-8640.

1Short and Long-Term Results of Connective Tissue Manipulation and Combined Ultrasound Therapy in Patients with Fibromyalgia, J Manipulative Physiol Ther 2006 (Sep); 29 (7): 524-528

Your Athlete and Chiropractic Care

By: Dr. Heather King DC, Serenity Health Care Center

What do Aaron Rogers, Greg Mathews, Michael Jordon, Tiger Woods and Evander Holyfield all have in common? 

They all see a chiropractor regularly.  Chiropractic care has been endorsed by most major professional and amateur sports associations and is used by athletes competing in both professional and amateur levels.  Whether it is the Super Bowl, Olympics, high school or youth competition, chiropractic care can help all athletes improve their game.

Chiropractic care is a safe, conservative noninvasive treatment approach to musculoskeletal complaints. Expert chiropractic treatment is effective in treating pain and discomfort in:

  • All areas of the spine
  • Feet
  • Knees
  • Hips
  • Shoulder
  • Elbow
  • Wrist and hand complaints

My primary goal for patients is to reduce and eliminate pain while addressing associated nervous system dysfunction.  Regular chiropractic treatment can help everyone function at his or her highest levels.  Injuries are a part of every athlete’s career.  Depending upon the type of injury chiropractic care can be an important part in helping athletes return to play.  A sore hip or foot might not sideline an athlete but can cause pain when running or jumping.

Having an evaluation by a chiropractor can help determine the cause, especially when there is no evidence of fracture or tear. 

 

Understanding Body Mechanics

Watching a high school volleyball player perform a spike over the net, they throw up the right arm and shoulder back and bring it forward with enough force to spike the ball to the floor.  The mechanics of that motion involve not only the spine but also the shoulder and surrounding muscles.  With this complex motion, it is easy to see how if one minor piece is not functioning properly it can cause her not to hit the ball as fast but slow down the entire process of spiking the ball.

Looking at the shoulders, I want them to be fairly even accounting for a difference in muscle tone due to increased use on the right side.  Examining the shoulder blade and surrounding area, we evaluate to see what could cause a biomechanical difference in her motion.  Muscle spasm along the edge of the shoulder blade, misalignment at the head of the shoulder, tightness in the front of the shoulder all could be some of the reasons she is not performing at her highest level.  A chiropractor can address all these problems.

Whether you enjoy spending your time kneeling in the garden, throwing a baseball towards home plate or tackling a running back, everyone wants to enjoy those activities pain-free.  Regular chiropractic care can help not only keep you at your top performance but help with the aches and pains that come from performing at your top level.

If you would like to schedule a chiropractic consultation, call Serenity Health Care Center at 262-522-8640.

A burden that is yours to Lose…Uncommon Factors That Hinder Weight Loss

The goal for the New Year is to create a new you. We all have goals and areas of our lives that need to be improved. Often the New Year is the time of the year a majority of Americans uses to examine their lives and set goals. Whether it is work related, home life or other areas many resolutions and goals are often set.

With this evaluation, time comes a frequently asked question, “am I happy with my current health?” In this discussion, we often come back to the subject of weight. Why is it we take this evaluation, make a complex issue, and “scale” it back to a number that stares up at us when we get on a scale? It is not that simple, just put “weight loss” into any search engine in the Internet! When I did this, I had 350,000,000 results in 0.49 seconds! If losing weight were as simple as eating less and exercising more, I would have some people in my practice ecstatic, because they are faithfully doing this but can’t see a return. Why would that be? Let’s first explore the current beliefs about weight.

Common factors that most people know which contribute to weight gain include:

  • Eating too many calories
  • Getting too little exercise
  • Genetics and family history
  • Some medication
  • Unhealthy lifestyle habits, such as skipping breakfast and not getting enough sleep.

Our beliefs around weight needs be expanded further and in doing that we begin to understand there are other factors, which contribute to weight gain. A successful weight loss program is formulated when the uncommonly thought off factors s to weight gain are addressed.

What is Body Composition?

At Serenity Healthcare Center’s clinical experience, we have seen the following uncommonly thought of factors that have contributed to our patient’s weight gain and lack of success when following all rules of diet and exercise:

  • Toxic exposure
  • Delayed food allergies
  • Consuming foods high in Glycemic value
  • Hormone imbalance
  • Poor adrenal function
  • Chronic infection
  • Thyroid imbalance and gastrointestinal dysbiosis

Our clinical experience demonstrates that these factors can contribute to weight. By looking at some of these underlying issues and addressing them, weight loss is easier to obtain.

Furthermore, the environment we live in exposes us too many chemicals that our body has to deal with. If our process of detoxification is not efficient in eliminating toxins, these harmful toxins can be stored in our fat tissue. If the fat tissue starts to break up with weight loss, the body does not want to deal with this load; weight loss can stall until this is addressed. We also see success with the supporting the genetics of detox. A gene called MTHFR plays a role in not only detox but also how we metabolize medications.

Delayed food allergies play a big role in the ability to lose weight. If a food that causes inflammation, irritation is consumed on a “special diet” to lose weight and your body can’t properly break this down this will also imped your progress.

Hormone imbalance is also a role.

Poor adrenal function impacts our base metabolic rate and by using adaptogens and adrenal support products energy and focus improve along with adjusting your metabolic weight. When the adrenals are not functioning this can contribute to poor sleep at night as well. The thyroid gland also plays a big role in the metabolic set point of our body. If the thyroid is not properly supported or sluggish, this contributes to inability to lose weight.

Want to learn more? Schedule a consultation as we can you help you achieve your health and weight loss goals.

Heart Disease: An Aging Problem

Heart Disease: An Aging Problem

Cardiac disease is a growing concern in our aging population 17.3 million people die a year from cardiac disease. By 2030 >23.6 million people will die from heart disease. People are developing heart disease at a younger age partially due to our poor quality food and lack of exercise. Decline in mitochondrial activity is also largely responsible for cardiovascular and neurological disorders as well as obesity and type II diabetes.

Heart Disease Health Facts

  • 50% of heart attack patients HAVE NORMAL LDL-C
  • SUDDEN DEATH is the first sign of cardiovascular disease in up to 50%
  • 10-24% of the world’s population has nonalcoholic fatty LIVER DISEASE
  • Metabolic Syndrome confers a twofold
increase in cardiovascular events and a 1.5X RISK OF DEATH

Loss of mitochondrial function in muscle tissue also leads to the familiar “flabby” body composition that causes muscle atrophy and increased body fat. Studies show that supplementation with carnitine can restore mitochondrial function to near-youthful levels. Total carnitine levels decline with aging and are roughly 20 % lower than in youth, leaving the mitochondria vulnerable to damage.

Heart muscles use fat as its primary form of energy source. This is why a no-fat diet is not recommended in Serenity’s heart health program. Carnitine is a fat-transporting compound that is absolutely essential for normal heart function. Carnitine increases nitric oxide that helps endothelial cells relax and increase blood flow, which can help lower blood pressure.

People with heart muscle damage from heart attacks or heart failure have especially low carnitine levels. Fortunately, carnitine supplementation has proven to be remarkable effective in fighting and even reversing the heart-weakening effects from that drop in carnitine levels. L-Carnitine supplementation prevents the progression of heart muscle damage in people with CHF and improves exercise with exertion.

Heart Disease Financial Facts

  • Yearly heart disease healthcare expenditure per individual $5693
  • Yearly fatty liver disease healthcare expenditure per individual $2600
  • Yearly metabolic syndrome healthcare expenditure per individual $2000

Do you want to save on your healthcare costs and better yet save your health? You must see the practitioners at Serenity Health Care Center to help you with your Cardiac Health. We can help you decipher your genetic information and create a plan for you that is as unique as you are.

If you have completed a lipid panel this is a great place to start but it is a basic group of tests to determine the risk for cardiovascular and related diseases. This test should always be combined with advanced testing to unveil a more accurate picture of total health. This will give specific information about your lipid profile so you will know if you should be worried about the abnormal lipid panel.

Lipoprotein particle size/number and Apolipoprotein concentrations reveal levels of good and bad cholesterol particles. Inflammatory processes are independent predictors of risk. Testing reveals the level of inflammation of blood vessels that may lead to plaque rupture, ultimately resulting in a heart attack or stroke. Advanced tests detect strain or other damage to the heart muscle. Metabolic markers can lead to early detection of diabetes and cardiovascular disease, which may reduce or eliminate a patient’s need for insulin. A Fatty Acid Profile is a potent indicator of the nutrients in a patient’s diet that can improve cardiovascular health.

Call today for an appointment to discuss Serenity Health Care Centers Cardiac Program 262-522-8640.

REFERENCES:

Noland RC, Koves TR, Seiler SE, et.al. Carnitine insufficiency caused by aging and overstimulation compromises mitochondrial performance and metabolic control. J Biol Chem. 2009 Aug 21;284 (34):22840-52

Terman A, Kurz T, Navratil M, Arriaga Ea, Brunk UT, Mitochondrial turnover and aging of long-lived postmitotic cells; the mitochondrial-lysosomal axis theory of aging. Antioxid Redox Signal. 2010 Apr;12(4):503-35

Chakrabarti S, Munshi S, Banerjee K, Thakurta IG, Sinha M, Bagh MB. Mitochondrial dysfunction during brain aging: role of oxidative stress and modulation by antioxidant supplementation. Aging Dis. 2011 Jun:2(3):242-56

Wang CH, Wang CC, Wei YH. Mitochondrial dysfunction in insulin insensitivity: implication of mitochondrial role in thyep 2 diabetes. Ann NY Acad Sci. 2010 Jul;1201:157-65

Pesce V. Fracasso F, Cassano P, Lezza AM, CAntatore P, Gadaleta MN. Acetyl-L-carnitine supplementation to old rats partially reverts the age-related mitochondrial decay of soleus muscle by activating peroxisome proliferator-activated receptor gamma coactivator-I-alpha-dependent mitochondrial biogenesis. Rejuvenation Res. 2010 Apr-Jun 13(2-3):148-51

Chao HH, Chen CH, Liu JC, Lin JW, Wong KL, Cheng TH. L-Carnitine attenuates angiotensin II-induced proliferation of cardiac fibroblasts: role of NADPH oxidase inhibition and decreased sphingosine-1-phosphate generation. J Nutr Biochem. 2010 Jul:21(7):580-8

Gomez LA, Heath SH, Hagen TM. Acetyl-L-Carntine supplementation reverses the age-related decline in carnitine palmitoyltransferase 1 (CPT1) activity in interfibrillar mitochondria without changing the L-carnitine content in the rat heart. Mech Ageing Dev. 2012 Feb-Marl 133 (2-3):99-106

Kobayashi A, Masumura Y, Yamazaki N. L-carnitine treatment for congestive heart failure-experimental and clinical study. Jpn Circ J. 1992 Jan;56(1) 86-94.

Bartels GL, Remme WJ, den Hartog FR, Wielenga RP, Kruijssen DA. Additional antischemic effects of long-term L-propionylcarnitine in angina patients treated with conventional antianginal therapy. Cardiovasc Drugs Ther. 1995 Dec;9(6):749-53

Molyneux R, Seymour AM, Bhandari S. Value of carnitine therapy in kidney dialysis patients and effects on cardiac function from human and animal studies. Curr Drug Targets. 2012 Feb; 13(2):285-93

Davinia P, Biagalli A, Lamanna F, Boem A. controlled study on L-carnitine therapeutic efficacy in post-infarction. Drugs Exp Clin Res.1992; 18(8):355-65

Stasi MA, Sciloi MG, Arcuri G, et al. Propionyl-L-Carnitine improves postishemic blood flow recovery and arteriogenetic revascularization and reduces endothelial NADPH-oxidase 4-mediated superoxide production. Arterioscler Thromb Vasc Biol. 2010 Mar;30(3);426-35

Lapi D, Sabatino L, Altobelli GG, Mondola P, Cimini V, Colantuonl A. Effects of propionyl-L-carnitine on ischemia-reperfusion injury in hamster cheek pouch microcirculation. Front Physiol 2010;1:132.

Gomez-Amores L, Mate A, Miguel-Carrasco JL., et al. L-carnitine attenuates oxidative stress in hypertension rats. J Nutr Biochem. 2007 Aug;18(8):553-40

Alvarez de Sotomayor M, Bueno R, Perez-Guerrero C, Herrera MD. Effect of L-carnitine and propionyl-L-Carnitine on endothelial function of small mesenteric arteries rom SHR. J Vasc Res. 2007;44(5):354-64

De Sotomayor MA, Mingorance C, Rodriguez-Rodriguez R, Marheunda E, Herrera MD. L-carnitine and its propionate; improvement of endothelia function in SHR through superoxide dismutase dependent mechanisms. Free Radical Res. 2007 Aug;41(8);884-91

Volek SR, Judelson DA, Silvestre R, et al. Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults. Am J Cardiol. 2008 Nov 15;102(10):1413-7

Loffredo L. Pignatelli P, Cangemi R, et al. Imbalance between nitric oxide generation and oxidative stress in patients with peripheral arterial disease effect of an antioxidant treatment. J Vasc Surg, 2006 Sep;44(3):525-30

Mingorance C, Duluc L, Chalopin M, et al. Propionyl-L-Carnitine corrects metabolic and cardiovascular alterations in diet-induced obese mice and improves liver respiratory chain activity. PloS One. 2012;7(3);e34268

Amin KA, Nagy MA. Effect of Carnitine and herbal mixture extract on obesity induced by high fat diet in rats. Diabetol Metab Syndr. 2009;1(1):17.

Mangou A. Grammatikopoulou MG, Mirkopoulou D, Sailer N, Kotzamanidis C, Tsigga M. Associations between diet quality, health status and diabetic complications in patients with type 2 diabetes and comorbid obesity. Endocrinol Nutr. 2012 Feb;59(2):109-16

Ringseis R, Keller J, Eder K. Role of carnitine in the regulation of glucose homeostasis and insulin sensitivity: evidence from in vivo and in vitro studies with carnitine supplementation and carnitine deficiency. Eur J Nutr 2012 Feb;51(1):1-18

Kang JS, Lee WK, yoon WK, et al. a combination of grape extract , green tea extract and L-carnitine improves high fat diet induced obesity, hyperlipidemia and non-alcoholic fatty liver disease in mice. Phytother Res. 2011 Dec;25 (12):1789-95

Malaguarnera M, Cammalleri L, Gargante MP, Vacante M, Colonna V Motta M. L-carnitine treatment reduces severity of physical and mental fatigue and increases cognitive function in centenarians: a randomized and controlled clinical trial. AM J Clin Nutr. 2007 Dec;86(6):1738-44.

Xia Y, Li Q, Zhong W, Donj J, Wang Z, Wang C. L-Carnitine ameliorated fatty liver in high calorie diet/STZ-induced type 2 diabetic mice by improving mitochondrial function. Diabetol Metab Syndr. 2011;3:31.

GMO Health Risks

GMO Health Risks: Genetically Engineered Organisms are found in our current food source and affect everyone of us who do not eat organic. There have been several serious health risks associated with genetically modified (GM) food, including infertility, immune problems, accelerated aging, faulty insulin regulation, and changes in major organs and the gastrointestinal system. In 2009 The AAEM American Academy of Environmental Medicine has asked physicians to advise all patients to avoid GM foods.

“Starting in 1996, Americans have been eating genetically modified (GM) ingredients in most processed foods. Why isn’t the FDA protecting us?” (Jeffery Smith)

In 1992, the Food and Drug Administration claimed they had no information showing that GM foods were substantially different from conventionally grown foods. Therefore they are safe to eat, and absolutely no safety studies were required to detect GMO health risks. There is proof that FDA scientists had repeatedly warned that GM foods can create unpredictable, hard-to-detect side effects, including allergies, toxins, new diseases, and nutritional problems. They urged long-term safety studies, but were ignored.

Today, the same biotech companies who have been found guilty of hiding toxic effects of their chemical products are in charge of determining whether their GM foods are safe.

GM plants, such as soybean, corn, cottonseed, and canola, have had foreign genes forced into their DNA. The inserted genes come from species, such as bacteria and viruses, which have never been in the human food supply. There are GMO health risks.

These foods are especially important to make sure these foods are consumed from organic sources. The other thing I would recommend is take environmental action against GMO Health Risks. Fight to remove GMO foods from our food source. Protect our children and grandchildren from the toxic exposures and medical conditions that occur because of this process.

Information adapted from http://www.responsibletechnology.org/health-risks, explore their website to learn more.

Do Hormones Really Protect Against Alzheimer’s Disease?

Most of us are aware of what Alzheimer’s disease is and we are afraid of getting it. This is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks. Alzheimer’s disease accounts for 60-80% of the dementia-affecting people. This is not just a disease of the elderly about 5% of 40-50 year olds are affected as well. There is not a current cure for Alzheimer’s disease.

Many menopausal women present with concerns of memory loss and are fearful that they are developing Alzheimer’s disease. There are things that people can do to beef up their memory and prevent dementia along the way. First and foremost start early with your prevention including following an organic diet, stimulate your mind with mental exercise, and stay physically active your entire life.

When it comes to using hormone therapy it is important to establish teenage levels of estrogen. Some researches suggest that only estriol should be used and not estradiol, I think it is important to use a ratio of both estriol and estradiol but this research is strong which makes me believe we should be changing our formulations to a higher strength of estriol compared to estradiol. It is important to make sure the body is not converting estrogen to estrone and that the hormone receptors are not stimulated into the wrong pathway. To prevent that in the past we would use DIM or IC3 but new evidence shows that a Chinese herb called Myomin is more effective in preventing this conversion to alpha estrogen receptor.

Testosterone is also known to be helpful in reducing the secretion of beta amyloid this same research indicates when progesterone is given daily it can interfere with estrogens ability to reduce the beta amyloid levels. When it is given in a cyclic fashion for 10 days of the month estrogen can do its work. The only concern with this is that we may not be able to protect the lining of the uterus from thickening, which can cause endometrial cancer. Each case should be reviewed on a case-by-case basis. Some women feel better with progesterone given daily if that is the case I think using small doses for 10 days and larger doses for 10 day to mimic a natural cycle.

Neprilysin is an enzyme that is reduced in Alzheimer’s that actually degrades beta amyloid and is increased with the use of estradiol and testosterone.

Hormones are not the only beneficial means for treating Alzheimer’s disease. Diet is key not only organic but choosing the proper foods based on genetics. Measure APOe genes to see if you carry the gene for Alzheimer’s disease. If you do the testing it is important to follow a specific diet to assist in reducing the inflammation in your body to prevent disease. This test can be ordered by anyone but having a knowledgeable provider assist you with your diet plan is key.

Talk to your provider today about how you can adjust your hormone program to help prevent Alzheimer’s disease.

Dealing with high PSA (Prostate Specific Antigen) levels

The PSA blood test is commonly used to check for signs of prostate cancer or other prostate problems. When a PSA level comes back high, the next step is usually recommended is a biopsy. But recent information suggests another possible option could be to repeat the PSA test a month or so later to monitor. This recommendation comes because PSA levels can fluctuate up and down — so a man with a high PSA level may not actually have any prostate problems at all. In fact, studies researching nearly 1,000 men, found that about half of those whose PSA levels were initially high had a normal result in a subsequent test according to James Eastham, MD, FACS, of Memorial Sloan-Kettering Cancer Center. There are three possible reasons for a high PSA; cancer, inflammation or infection of the prostate or lab error.

According to Eastham a man should not undergo a biopsy of the prostate based on one high PSA level. I would agree with this and recommend trying to evaluate other possibilities for a high level and monitor. I would go further to recommend various supplements to assist in lowering the PSA level. Here is a list of supplements and their doses that have been researched and can assist in lowering the PSA level. A word of caution that if you use these supplements and the PSA doesn’t go down you should seek medical care.

For Psa levels higher than 1.0 add boron at 6-15mg a day, consider adding prescription Avodart to reduce levels quickly. ECGc (green tea) can be dosed at 1300 mg a day. Lycopene 10 mg a day has been shown to reduce cancer by 30%. Adding DIM or IC3 has been helpful to lower estrogen levels but a newer Chinese herb called Myomin can be more beneficial because it lowers estrogen futher up the pathway. Curcumin can be helpful for inflammation using 300-600 mg a day has been studied. Vitamin D levels should be measured and dosed appropriately.

If you suffer from a high PSA level get assistance and evaluation for this condition and be monitored closely.

Is Your Nervous System Functioning Properly?

Is Your Nervous System Functioning Properly?

The nervous system functioning is affected greatly in autism. The effected nervous system can be responsible for things such as hyperactivity, attention issues, sleep disturbances, behavior problems, social issues, sensory processing issues and can be linked to digestive and immune system functions. Bowel and bladder problems and autoimmune dysfunction can also be linked to nervous system deficiencies. A child with autism’s nervous system can be in a constant state of stress or flight/fight response. Most children with autism have been stuck in a flight/fight response for longer than they have been diagnosed. By addressing the stress to the nervous system the goal of chiropractic care is to help restore proper function to the nervous system and allow the body to function to its highest ability.

Did you know that Serenity Health Care offers chiropractic care? Set up your appointment today with Dr King.


What do you do when you suffer from a pounding headache or migraine? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.

A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.

Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication. http://www.acatoday.org/

Did you know that Serenity Health Care offers chiropractic care? Set up your appointment today with Dr King.

The nervous system functioning is affected greatly by chronic pain. The nervous system can be responsible for things such as lack of energy, attention issues, sleep disturbances and it can also be linked to digestive and immune system dysfunction. Bowel and bladder problems and autoimmune disorders can also be linked to nervous system deficiencies. By addressing the stress to the nervous system functioning, the goal of chiropractic care is to help restore proper function to the nervous system and allow the body to function to its highest ability.

Did you know that Serenity Health Care offers chiropractic care? Set up your appointment today.

  • 1
  • 2