Many of us seek complementary and alternative medicine (CAM) remedies. But how many of us look to CAM remedies for our children?

It was recently reported that nearly 12% of all children in the United States have used some form of complementary and alternative medicine (CAM).

Based on the National Health Interview Survey of 2007, a group of researchers at Harvard Medical School gathered information on CAM use among more than 9,000 children younger than 18 years. Based on these data, the authors estimated that greater than 8 Million children below the age of 18 years used some CAM remedy during the year these data were collected (2007).

Their findings were published in the February issue of Pediatrics, 2010.

This study focused on chiropractic and osteopathy, homeopathy, yoga, herbal and natural products, and other similar CAM remedies. They did not include common supplements such as vitamins.

Like Parent, Like Child

Not surprisingly, they reported that the used of CAM among children was much more likely among children whose parents also used CAM remedies: like parent, like child.

CAM for Chronic Illnesses

CAM use was also more likely among these groups of children:

• Children with multiple and complicated heart conditions
• Adolescents aged 12-17 years
• Children for whom conventional medical care had been either delayed or avoided due to cost
• Children with chronic conditions such as pain, anxiety, stress, and sinusitis

The use of CAM in those with chronic conditions often represents a trial from patients who are disillusioned or frustrated with the lack of relief from conventional therapies.

Increased Prescription Drug Use Associated with Increased CAM Use

Use of CAM remedies was also associated with the use of prescription medications.

In other words, these people are more likely to be seeking ANY remedy that can help them. Think about the groups listed above – those with chronic illnesses are looking for anything that can help bring them to health.

Dr. Birdee, the lead author of the study, commented that this association raises the potential for drug-herbal interactions. He noted that only about half of adult patients report their use of herbal and dietary supplements to their physicians.

Better Communication for Safety

Many physicians forget to ask about use of herbs or supplements by children. Many parents forget to mention supplements that their children are taking. Thus, it bears reminding everyone that we should be communicating our use of supplements to our doctors, and we doctors should be remembering to ask.

The authors of the study concluded that more information is needed on CAM remedies, especially in children. Studies are being conducted by the National Center for Complementary and Alternative Medicine at the National Institutes of Health. There website is an excellent resource.

Points for Parents:

• Treat herbal and other nutritional supplements and vitamins with the same care and caution that you would for any other medication:
  • Store them out of reach of your children
  • Do not alter the dosing – use as any other medication: more is not necessarily better
  • Be cautious if pregnant or nursing – some medications, including herbs or supplements, can affect the developing fetus or nursing infant
  • Confirm the child’s diagnosis: you don’t want to be treating the wrong disorder, regardless of the remedy; unless you are a physician, avoid the temptation to diagnose
  • If your child experiences any reaction associated with conventional or CAM remedies, stop its use and contact your child’s physician

Resources:

The website for the National Center for Complementary and Alternative Medicine at the National Institutes of Health is an excellent resource for further information:  http://nccam.nih.gov/

Birdee, Phillips, Davis, Gardiner. Factors associated with pediatric use of complementary and alternative medicine. Pediatrics. 125: 249-256; 2010.

Breuner. Complementary medicine in pediatrics: a review of acupuncture, homeopathy, massage, and chiropractic therapies. Current Problems in Pediatric and Adolescent Health Care. 32: 353-384; 2002.

Committee on Children with Disabilities, American Academy of Pediatrics. Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability. Pediatrics. 107: 598-601; 2001.

Mehta, Gardiner, Phillips, McCarthy. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Alternative Complementary Medicine. 14: 1263-1269; 2008.

Faust. A few words about being natural: http://www.boogordoctor.com/2010/06/a-few-words-about-being-natural/.

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Hi, I’m Russell Faust, author of this medical education blog.

Image: Russell Faust

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later – we will be going into more detail on how to rid your children of allergies, rhinitis, sinusitis, and other chronic aero-digestive inflammatory disorders on this site.

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Stay informed.

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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

What Causes Reflux?

Let’s start the answer by saying “we don’t know”. The rest is mostly speculation, educated guessing. At the bottom of the esophagus (swallowing tube) there is a tightening of muscle where it enters the stomach (called the “lower esophageal sphincter”). This muscle is affected by many things. As you might imagine, anything that loosens that muscle will allow reflux to worsen. Some things that loosen that muscle include caffeine, alcohol, tobacco, mint teas, tight clothing (pressing on the stomach externally), lying down, and even obesity. Some medications also worsen reflux. Let’s assume that your infant isn’t smoking cigarettes, drinking alcohol or coffee. You can see that most of these factors should not be a problem for babies or children, although obesity is becoming more of a problem in children. The biggest factor for reflux in infants is position – they spend most of their time lying down.

What To Do About It?

General Considerations

1. Manage stress. Stress and emotional turmoil will crank up the stomach acid, and have other negative effects. Too much can contribute to reflux, GERD. As always, to the best of your ability, provide your child with unconditional love, emotional support, and a safe and secure home environment.
2. Consider an Elimination Diet protocol. Some specific foods or food groups may be causing reflux or respiratory symptoms (asthma, rhinitis, etc.). Eliminating your child’s symptoms may be as simple as getting rid of a food from their diet. This topic deserves a LONG post all by itself. Take a look at Dr. Jonega’s site (www.allergynutrition.com), take a look at her books (on my Amazon Store here), and search the web for “elimination diet”.
3. Exercise. For children (adults too), make certain they are active. This will benefit their general health. It will help eliminate reflux. Get them up off the couch, pry them away from the video game and the TV, get them outside!!
4. Supplement with a multi-vitamin that contains zinc. Zinc is necessary for a healthy GI tract.
5. Consider using a probiotic for any child who is being treated for reflux (any treatment – conventional or alternative).

Infants

Simple things can help: after feeding try to keep them upright for awhile. If sleeping, try to place them on a slight incline, or prop up their bedding slightly under the head of the crib. Thickening their feedings can help them keep from refluxing. Rice cereal is a good thickener. For this to help, the formula or milk needs to be as thick as stage 1 baby food or tomato sauce (NOT paste!). Note that breast milk contains an enzyme that breaks down the cereal, so it will be good and thick to start, but thins out a few minutes later. You may want to thicken only an ounce at a time to prevent this from happening. Also note that thickened formula will not come out of a regular bottle nipple. Most bottle manufacturers have cross cut nipples and variable flow nipples. Ask your pharmacist to order some for you. Finally:  Not ALL reflux will be cured by thickening.

What Other Treatments Are Available?

For starters, “conventional” medicine uses something that is over-the-counter for adults (considered relatively safe):

Zantac (generic: Ranitidine)

I have had good results with this in my pediatric patients with  asthma, rhinitis, sinusitis, and otitis. It is a prescription for children. I use this mostly as a diagnostic technique: if I suspect reflux as a key factor in a child’s asthma, rhinitis, sinusitis, or otitis, I will place them on Ranitidine. If they clearly improve, we have our diagnosis. We then try to reduce the reflux without drugs. Keep reading …

Natural Alternatives

Here are some “natural” alternatives to consider (see my previous article, A Few Words on Being Natural (http://wp.me/pR4iB-k5) for my thoughts on whether “natural” is always better):

DGL

In the 1940’s licorice was discovered to be effective in treating peptic ulcers. Unfortunately, side effects included high blood pressure, potassium loss, and fluid retention (just another example of “natural” not always being a universally positive remedy). Over time it was discovered that these side effects were caused by a chemical in licorice – glycyrrhizin. The solution is called “de-glycyrrhizinized licorice”, or DGL, where about 97% of the glycyrrhizin has been removed. Research has shown that DGL is a good anti-inflammatory. It has been effective against the esophagitis and other symptoms caused by GERD. How to use DGL? It usually comes as a chewy tablet, kind of like a gummy-bear. Chewing the tablet helps activate the DGL by mixing with saliva.

NOTE that safety information for DGL in children are not available. Dosing information is not available for children. Therefore, this option is only available for treating adult reflux. If you use DGL, store it out of reach of children – the gummy-bear resemblance to candy can be appealing to children.

Barley Grass

That’s a pic of barley grass above (credit, Matt Lavin). Barley grass consumption by humans dates back at least 7,000 years, and active cultivation of barley dates back to Mesopotamia, to about 2500 BC. Barley has amino acids and chlorophyll, and seems to contain effective anti-inflammatory ingredients. In addition, it has 11 times the calcium of cow’s milk, more than 4 times the iron from spinach, 7 times the Vitamin C of oranges, and is loaded with Vitamin B1. Sounds impressive. There has been very little scholarly research on the effects of Barley Grass in humans. It is used as an anti-inflammatory for reflux, similar to DGL. How to use Barley Grass? Dried barley grass is usually boiled and consumed as a tea, or mixed into water or juice.

Melatonin?

You’ve heard of Melatonin? Helps us sleep. This mostly speculation, but some integrative and holistic docs who are pretty smart speculate that our Melatonin also helps reduce reflux. How? Melatonin increases the muscle tone in the Lower Esophageal Sphincter. This might reduce upward flow of gastric contents. That is, increasing the tone in the LES might reduce reflux. Still speculation, but it makes sense that the natural hormone that helps us sleep would also help reduce reflux while we are lying down.

Histamine?

No – don’t give histamine to treat reflux. Reduce histamine to reduce reflux.

For my own reflux, Dr. Joneja’s histamine-restricted diet has made a huge difference! Check her site under Resources, below. It is a GREAT resource for those with food allergies, intolerance, and reflux. She has many free downloads. She has an amazing site! Check it out!

Quercetin

Quercetin is a bioflavonoid. It inhibits release of both histamine and leukotrienes. As a result, it is a strong anti-inflammatory agent. It occurs naturally in onions, garlic, and many dark-colored fruits and vegetables. Ask your pharmacist or naturopathic doctor (ND) about dosing for children. Even better, simply include natural sources in your child’s diet (in your diet too, while you’re at it). As a general principal, it is always better to get your nutrients directly from the source – your food.

Acupuncture

As good at managing reflux as powerful proton pump inhibitors (PPI’s) for difficult-to-treat reflux. I don’t use PPI’s in my patients. To find a Licensed Acupunturist near you, contact the American Academy of Medical Acupunture (see Resources, below).

Nutritional Supplements

There are studies suggesting that magnesium and other elements play a role in histamine release. Be certain that your little tyke has as well-rounded a diet as possible (see Littlestomaks.com for suggestions). The goal, of course, is for them to obtain all of their nutrients from a well-balanced diet. This is a huge challenge, especially in toddlers. Supplement with a good multi-vitamin to be sure. This simple step will help minimize reflux, and help keep them healthy in general. Be certain that the multi-vitamin includes Zinc. Nearly all of us are deficient in Zinc, and it helps the lining of the GI tract to heal, to repair itself. Ginger can have a “gastro-protective” effect – it protects the stomach. BUT: Caution should be taken when using ginger (Zingiber officinale), as some studies have found increased GI distress with high doses or prolonged use. So: if you have reflux, don’t over-do the ginger. Finally, ask your doctor – naturopath, pediatrician, or pediatric ENT. Check the website of the American Board of Integrative Holistic Medicine to locate an integrative healer near you: http://integrativeholisticdoctors.org/D/locate_physician.html

Surgery

As a LAST resort: For those children with life-threatening complications of reflux – failure to thrive, severe asthma, recurrent pneumonia from aspiration, etc. – and these other approaches just are not working – surgery may be a consideration. The most common and most successful is a procedure that tightens the lower esophageal sphincter, the muscle surrounding the esophagus where it enters the stomach. I do not personally perform this procedure, and can only say that some of my patients have experienced life-changing success from surgery to stop their reflux. Beyond that, ask your doc, search the web. . Reminder: the goal of these articles is to educate and inform. This is not medical advice. All treatment should be undertaken with the advice and guidance of a physician who has knowledge of your full medical history, your physical exam and any laboratory test details. See disclaimer: http://wp.me/PR4iB-r Future posts will examine the studies showing how reflux affects rhinitis and sinusitis, and what we can do about it. . I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.” I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday. Click here to subscribe for free weekly updates: (http://eepurl.com/FGnP) Type in your best email address (the one you actually use).  When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book or product reviews, without needing to visit the website. It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time.

Stay Informed.

Stay Healthy.

Best of health and success to you and your families. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources

American Academy of Medical Acupunture.  Tel: 323-938-5514. Website:  www.medicalacupuncture.org

Dr. Janice Joneja, PhD, RD (Registered Dietician): http://www.allergynutrition.com/)

This is an outstanding resource for allergy and nutrition information, including food allergies and reflux.

I owe a great debt of gratitude to Dr. Robert Ivker for helping to eliminate chronic sinusitis and reflux from my life.

Refer to his site for further details on steps that you can take: www.physicianhealer.com He is an outstanding resource for Respiratory Health.

Of note, he is an original founder of the American Board of Integrative Holistic Medicine.

Image Credit: Image by Matt Lavin, Flickr:  http://www.flickr.com/photos/plant_diversity/

From this blog:

Is Reflux Causing Your Child’s Asthma? http://wp.me/pR4iB-uV

Things You Should Know About Asthma: http://wp.me/pR4iB-7k

A Few Words About “Being Natural”: http://wp.me/pR4iB-k5

Reflux and Otitis: Does GERD Cause Ear Infections? http://wp.me/pR4iB-fZ

Honey is a natural antibiotic !!  Who knew?

Well, it seems that ancient humans knew:  For over 2 thousand years humans have used honey applied topically to treat a variety of ailments.  Only recently have we found scientific evidence to help understand honey’s antibiotic activity.

It is now well established that honey helps inhibit the growth of a wide variety of bacteria.  There are even honey-containing wound gels that help eliminate the dreaded MRSA (see ManukaMedical in resources, below).  Cool.

And you may have heard about the role of biofilms in chronic infections (including rhinosinusitis)?

Well, honey has been shown to be effective in killing drug-resistant, biofilm-forming bacteria that are implicated in chronic rhinosinusitis, including MRSA and pseudomonas.  Very cool !!

Why is honey such a great antibiotic?

4 Reasons:

• Osmotic effect – high concentration of 2 monosaccharides (sugars), with low water content – draws water out of bacteria (dehydrates them), making it extremely difficult for them to grow in the presence of honey
• Hydrogen peroxide – the glucose oxidase in honey slowly generates hydrogen peroxide from the sugars; as you know, hydrogen peroxide is an excellent antiseptic.  Thus, honey is a natural slow-release antiseptic
• The acid – low pH (acidity) of honey naturally prevents growth of bacteria
• It’s got mojo:  honey has variable amounts of methylglyoxal (MGO – let’s just call it “mojo”), which is another natural antibacterial agent

How to use this information:

What does this mean for you or your little one’s sinusitis?  Well, adding honey to your sinus saline rinses can be hugely beneficial, especially for those with chronic and recurrent sinusitis.

In my clinical practice, I recommend this for children who never seem to completely recover from their sinusitis.  The addition of honey (along with some other tricks) has proven to be beneficial for these kids.

Check out recent blog post, “Sinus Rinses: if once/day is good, is 4x/day even better?,” for making your own saline rinse recipe that includes Manuka honey.

Alternatively, simply add some honey (same proportions as recipe in blog post) to your store-bought saline solution.  Either way, this may be just the ticket to eliminating the bacterial biofilm that is causing your (or your child’s) chronic sinusitis problem.

We’ll discuss biofilms and their role in chronic infections in a future article.

Not all honey is created equal:

In fact, the Manuka honey from New Zealand, and Sidr honey from Yemen, seem to have antimicrobial properties above and beyond your average honey.  Medicinal-grade Manuka has more mojo, and is reported to have other (as yet unidentified) micronutrient agents that act to enhance its antibiotic activity.

Exotic:

Note that these specialty, medicinal honeys can get very pricey.  They can be difficult to find locally.  The explosion in alternative and natural remedies (like those reviewed on this blog) has increased demand for Manuka honey in the past year.  Check the boogor doctor’s Amazon Store on the right column (disclaimer: Amazon affiliate) for quality Manuka honey at moderate price (still steep).

Local:

You might try your local farmer’s market for more reasonably-priced varieties collected close to home.  It is also suggested, though not proven, that eating raw local honey can help build immune tolerance to local allergens.   Though not as potent as Manuka, they will still have some antibiotic activity, like all honey does for the reasons outlined above.  Also, you will be helping your local economy, and helping an apiarist (the term for a beekeeper; beekeeping = apiculture) to stay in business.   We won’t go into the difficulties that honey bees are having right now, but support them in any way possible.

Summary:

This post does not even touch on the many, many other uses for Manuka honey that are being discovered, or re-discovered.  Check some of the resources below for more.

Note that “pasteurizing” honey by heating it kills the hydrogen peroxide and any other active enzymes in it.  Therefore, whether using Manuka or locally grown honey, use it raw.

WARNING: All honey, but especially raw honey, contains the spores of botulinus. While this is not a problem for adults, children under the age of one year may not have enough stomach acid to prevent these spores from developing into botulism, a deadly poison. For the same reason, I advise caution for children or adults who are on medications that suppress stomach acid using proton-pump inhibitor (although I have not seen it reported in the medical literature).

NOTE: when adding Manuka honey to saline sinus rinse, warm gently to dissolve – over-heating will kill useful enzymes and proteins.

Check the boogor doctor’s Amazon Store (right side of page) for a couple reasonably-priced (for Manuka) samples of Manuka honey and other resources for doing saline nasal rinses.  The Sidr honey from Yemen is much more difficult to obtain, and there is much less scientific medical information available about Sidr honey than there is for Manuka honey.

To download this article as a free PDF file: http://wp.me/PR4iB-s7

Thanks for visiting, and see you here again.  I appreciate your comments and questions.  Keep ‘em coming.  And please, “be excellent to one another.”

If this blog is helpful for you, please click here to subscribe for email updates (it’s FREE):

Simply type your best email address (the one you actually use) into the orange-outlined box at the upper right of the page, and click the subscribe button. When you receive the confirmation email, click on the link to give your okay to receive weekly email updates.

No advertising, no spam.  It’s easy, it’s convenient, it’s free. You can un-subscribe any time.

Stay informed, stay healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources:

http://bio.waikato.ac.nz/honey/special.shtml for what’s so special about Manuka honey.

Effectiveness of honey on Staphylococcus aureus and Pseudomonas aeruginosa biofilms. Alandejani, et al. (2009). Otolaryngology – Head and Neck Surgery, vol. 141: 114-118.

Honey: nutritional and medicinal value.  Khan, et al. (2007) International Journal of Clinical Practice, vol. 61(10): 1705-1707.

A Comparison Between Medical Grade Honey and Table Honeys in Relation to Antimicrobial Efficacy:  http://bit.ly/bcv8lO (Online Journal, WOUNDS;  publication date: Feb. 12, 2009)

Great review of honey’s history and medicinal uses: http://digg.com/u1QgOp

http://www.benefits-of-honey.com/

http://www.medicalhoney.com/

http://manukahoneyproducts.com/

How bacteria build a “shield” against your immune system – BIOFILM: http://bit.ly/2mv2La

Recurrent and chronic sinusitis have a greater negative impact on quality of life than other chronic diseases (like rheumatoid arthritis, heart disease, diabetes).  Granted, those disorders are no picnic either, but – according to the kids and their parents – chronic sinusitis had a greater negative effect on quality of life when compared to these other diseases.

Co-Morbid

It is difficult to separate recurrent and chronic sinusitis, or chronic rhinosinusitis (CRS), from allergic rhinitis.  Over half of those with CRS have a history of allergic rhinitis. They share many of the same symptoms.  This means that many of the following tips will be helpful for children with allergies or sinusitis (or, commonly, both).  If your child also has asthma, eliminating their sinusitis will improve their quality of life.

The 8 General Principles

1. HYDRATE ! – keep your child hydrated, use a humidifier at night, use daily saline sinus irrigations, and use a small spray bottle of saline to maintain nasal moisture and optimize nasal / sinus hygiene.  Keep those respiratory cilia happy.  See my post on Sinus Anatomy and Histology.  If you haven’t tried saline nasal rinses, check out my 4-part series on whether they are effective, how to do them, how to make the saline solution, and other details.
   Keeping them hydrated will also improve clearance of nasal and sinus secretions by keeping them thin.  That’s a good thing.
2. Minimize antibiotic use – When good bacteria are killed by overuse of antibiotics, some bad bacteria (or molds) that are unaffected by that antibiotic, will overgrow. Good bacteria are essential to maintain a healthy immune system.  Fungal sinusitis caused by molds can be even worse than bacterial sinusitis, so beware.
3. Make certain that your child sleeps and eats well – plenty of rest and good nutrition help maintain a strong immune system.  An altered immune system is believed to play a key role in chronic rhinosinusitis, and in fungal sinusitis.
4. Treat allergies –The majority of people with sinusitis have a history of allergic rhinitis. Get ‘em tested, get ‘em treated.  A good Pediatric Allergist will help figure it all out.  See my post on how to control Allergic Rhinitis for more.
5. In the meantime, try to minimize use of over-the-counter allergy treatments like antihistamines.  They can cause thickening of nasal secretions, resulting in reduced mucociliary clearance – that’s a bad thing.  Keep those cilia happy.  Consider using Quercetin, a naturally occurring bioflavonoid, that helps reduce the inflammation of the nasal epithelium that is associated with allergies and sinusitis.
6. For sinus pain, try acupressure: search “acupressure” for some great websites on this remedy.  For sinusitis, you can simply use the right forefinger and thumb to grasp the fleshy part of your child’s left hand that makes a ‘V’ between the thumb and forefinger, gently squeeze, massage for 10-15 seconds.  This can significantly reduce the sense of facial sinus pain and pressure. (pregnant women should not do this maneuver – it may elicit premature contractions)
7. Consider Probiotics – What are Probiotics?  The World Health Organization defines Probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.”  If your child absolutely must be taking antibiotics consider supplementing their diet with Probiotic capsules, or simply feeding them live-culture yogurt.  There is growing scientific support for the benefits of Probiotics in several areas of medicine.  There will be more in a future post, as several people have contacted me asking for information.
8. Purify your air – Replace your furnace filters!  No, they were not meant to be replaced every 15 years.  You knew that, right?  Check them every month!  Replace them every year (at least), more often if you have pets.  Vacuum every week, more often if you have pets.
   See my posts on air quality, and how to detoxify your indoor air.
   Stop Smoking!!  ‘Nuf said.

Bonus Principles

Bonus 9. and 10. These two other recommendations that I normally reserve for adults are acupuncture, and spicy foods (cayenne, capscacin), since most children are freaked by needles (most adults too for that matter), and most won’t tolerate spicy hot foods.  (My kids think that ketchup is too spicy ;~D)

Bonus 11. If your child is old enough and interested, consider the various yoga positions for sinusitis.

Bonus 12.  Sinusitis and Reflux

If your child has chronic sinusitis, consider that they may have reflux – GERD – that is contributing.  Check back here for posts on reflux.  Search the web for information on pediatric reflux and sinusitis.  All of the pediatric otolaryngologists that I know believe that reflux contributes to chronic sinusitis in children.  All of them.  This is too big of a topic to cover here, and will be covered in detail in separate posts.

There is a post coming up next month on the Unified Airway Model that you may find interesting, and useful.

Conclusion

Most of these principles are not difficult.  Not too burdensome to put into action.  Together, they can make a difference in your little boogor-head’s quality of life.  Give them a try.

To download this post as a pdf: http://scr.bi/aL3CPw or on the download page of this blog: http://wp.me/PR4iB-s7

What tips do you have for managing your child (or adult) with chronic sinusitis?
What works, what doesn’t work?  Please leave a comment, let us know so we can all learn.

Check back here every week for more information on getting your kiddo to optimal health.
Continue to “be excellent to one another.”

Best of health and success to you and your families.

If this blog is helpful for you, please click here to subscribe for email updates (it’s FREE):

Simply type your best email address (the one you actually use) into the orange-outlined box at the upper right of the page, and click the subscribe button. When you receive the confirmation email, click on the link to give your okay to receive weekly email updates.

No advertising, no spam.  It’s easy, it’s convenient, it’s free. You can un-subscribe any time.

Stay informed, stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)