Customized Medicines

Customized Medicines
Dr. Sonja O'Bryan, Pharm.D., ABAAHP Board Certified Health Practitioner Diplomate-American Academy of Anti-Aging Medicine: "Creative Medicines" for Hormones-Weight-Pain-Fatigue-Skin Diseases-Pediatrics-Autoimmune Disorders-Veterinary Needs. Using Complimentary, Integrative, Regenerative, Bio-Identical, and Lifestyle Medicine For Health and Healing.

Tuesday, November 1, 2016

The #1 Contributor to Better Health and Wellness

Oh my.....this is an article of a different kind.

I've had this topic on my mind for some time now and finally found the time to sit down and gather some thoughts and clinical evidence to help people in realizing what the BIGgest contributor to better health and wellness is.  In any given day, I respond to countless questions and sit down in private consultations reviewing health histories, lab values, family diseases, medications, supplements, and the like.  However, as I work with an individual, I'm always keenly in tune to something that is more important than any custom therapy or regimen that I could design for them.  It's not something that I create and dispense in a bottle, but it far surpasses anything on the pharmacy shelves when it comes to overall health, sense of wellness, and success in achieving a goal.  So what is it?  (I'm glad you asked)

Actually the question is not, "what is it?"but instead, "who is it?"  Humans are complex social creatures often defined by family, language, culture, nationality, religion, race, or perhaps even trade.  We are born into some of these groups, but we can choose to join others. Did you know that our PURPOSE is very much intertwined with the people we interact with (or perhaps those we choose not to interact with)? Scientific study results show that a higher level of purpose in life, through our personal associations, is associated with better health, increased participation and productivity, better socioeconomic status, and better outcomes for persons with addiction.  Even patients with Alzheimers were reported to have better cognitive function, despite their disease, when surrounded by positive people and purpose. In other words, your social network could be thrusting you forward, or pulling you down.  Now hold on, I'm not suggesting that you dump all of your friends, but I am suggesting that you pay attention to those that make you feel joy, strength, positive, at ease, and purposeful about life.  This important health contributor alone can make or break you. Literally!

Now let me touch on some specific details and evidence....

Weight Loss Success
When it comes to weight loss coaching, I'm very strategic to cover social networks with an individual.  In a published study of over 12,000 people followed for over 30 years, here's what the results showed. "A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73)"  The bottom line is that, those people in your social network can propel you to your weight loss goal, or they can inhibit you in your success.  If you want to be successful at weight loss, make sure you have your family and friends on board with you. We all know it's a real drag to watch the family eating pizza and sugar donuts while we're up to our greens in leaf lettuce. So not fair right?

Family Dynamics 
 Basic family dynamics can have an overall impact on health.  It has been known for many years that marriage increases life expectancy, especially in men. Family stability also helps adolescents avoid poor lifestyle decisions and children in a stable and loving home have a better chance at doing well in their life goals.  I've always followed and parented by the standard that "our children only have ONE chance at a happy childhood." If they feel engaged, loved, and a sense of belonging to that family unit, they will do "life" much better. The family circle of influence can be very healthy, or very unhealthy.

Religious services
There's evidence supporting longer life expectancy in those that regularly attend religious services compared to those who rarely or never do. According to data published in 1999 this can translate into a seven-year difference in life expectancy.  This does not mean that private spirituality is not beneficial, but that social group gathering and interaction with others is healthy all the more.  Faith and purpose go hand in hand.  It's healthy!

Your team
If you are a professional, a leader, or in business here's a big secret to success and 'purpose' in what you are doing.  Make sure to line up the "who" before you chase the "what". In the book Good to Great, Jim Collin's leading point is that you need the right people on the bus before you decide where to take the bus.  People are not your greatest asset.  The RIGHT people (your team) are your greatest asset! Real success takes more than just YOU to get where you want to go.  Everyone can feel purpose when you're all on the same page and working towards a common goal.  It's healthy!

You can ask those in 'my circle' about this personal attribute deep inside me.  If I'm in, I'm All-IN.  I choose my social network very carefully these days ( wasn't always that way).  There's nothing so healthy as being surrounded by personal connections or a 'community' where everyone is genuinely concerned about the group's health, but even more importantly, concerned about each of the individuals that make up the group.  If you feel consistently drained by a certain someone(s) inside a circle of influence, then maybe it's time to step back and evaluate the impact on you, your health, and your goals to achieve success.  It's healthy to do so!

This is not my typical blog on hormones, supplements, testing, etc. but it is so, so, so important to overall health.  If you are working at your best in the physiological areas and missing the link in social and emotional areas, then you're going to be sub-optimal in your quest to achieve better health.  Evaluate your purpose today and figure out what,  I mean who, is in the benefit column and who is in the deduction column.  Hopefully the positives will far outweigh the negatives.

All the best,

Dr. Sonja

Wednesday, July 6, 2016

Hormone Health in Men


Andropause: Real Men Go For Balance           

The first thing a man entering andropause generally notices is a subtle downward shift in strength and energy as hormone levels taper off. Muscle tone and stamina are the first to go and he starts to gain weight and that "spare tire." He may also develop a voracious appetite and food cravings he never had before. As symptoms kick in at mid-life, hormone testing can identify hidden imbalances that complicate symptoms of andropause and contribute to rapid aging.

The 2006 HIM Study found that nearly 40% of US males over 45 years old had low testosterone levels (an estimated 13 million US males), however the majority of men in the study did not recognize that the weight gain, sore muscles, lack of libido, insomnia, and burnout they were experiencing could have something to do with andropause and hormone imbalance – instead they put their symptoms down to "just getting old."
Getting old was the recurrent theme at a recent 50th birthday party I attended where non-stop over the hill jokes and "low-T" lamentations were heaped upon the birthday boy. All that talk of testosterone reminded me of an article in Atlantic magazine a few years ago that slammed the drug industry’s promotion of supplemental testosterone as "god's gift to men," and questioned whether every modern man really needs testosterone?
One way to begin to answer that question is to start with physiology and understand that the androgens (primarily testosterone and DHEA) in their natural state bestow the heavier bone and muscle mass, deeper voice, drive and virility we associate with the male of the species. And that when they start to decline around the age of 45, the average Joe will experience some of the following symptoms:
  • Decreased strength/stamina/endurance
  • Decreased muscle mass/sore muscles
  • Weight gain in the hips, thighs, waist, and/or breasts
  • Increased body fat
  • Poor recovery from exercise
  • Burnout and fatigue
  • Lack of mental clarity
  • Decreased sex drive and/or competitive drive
  • Prostate problems
The natural decline of hormone levels in aging men also poses an increased cardiovascular risk which is where the controversy over replacement therapy comes in: whether it can hurt or help healthy men, and those who already have heart disease. It's an important question, particularly in light of the skyrocketing numbers of men using testosterone products to feel better and to increase muscle mass and energy. According to the FDA, the use of testosterone therapies increased from 1.3 million patients in 2009 to 2.3 million patients in 2013, a doubling of prescriptions in less than five years. In light of these numbers and that the risks vs. benefits of androgen supplementation in men have not been clearly identified, the Atlantic article raised some important questions, for which recent research has some good answers.

If the need is clearly established and monitored through hormone testing, supplementing testosterone can be beneficial.

Replacement has its place

In a 2015 study of 1472 generally healthy men between the ages of 52 and 63 with no history of heart disease, researchers found that those who received testosterone supplementation to achieve normal levels did not increase their risk of heart attack stroke or death but actually showed a reduction of risk compared to patients not on testosterone therapy. Even more good news came in a follow-up study this year (2016) of 755 male patients between the ages of 58 and 78, all with severe coronary artery disease. Researchers found that the men who received testosterone therapy as part of their follow-up treatment fared much better than those who didn't. In fact, the non-testosterone therapy patients were 80 percent more likely to suffer an adverse event.

Its always about balance

Aging is inevitable and dropping hormone levels go with the territory, but what is not inevitable, is how rapid or steep the decline in hormones needs to be. Whether men age well, or rapidly, depends a great deal on their stress levels, diet, exercise, alcohol intake, weight gain etc. For example, the more overweight the man, the more estrogen he will churn out in his fat cells, creating a surplus in relation to waning testosterone, and a raft of estrogen related symptoms, like moodiness, depression, and female pattern of weight distribution in the hips, thighs, and breast tissue. (A fact that should not be lost on those concerned about prostate health is that estrogen is a growth hormone linked with the development of prostate cancer.)
Experts in the field of hormone testing and balance, like Dr. David Zava, owner of ZRT Laboratory will tell you that where the need is clearly established and monitored through testing, supplementing with testosterone can be beneficial, particularly, when used in tandem with a healthy lifestyle.

Men in balance do these things during andropause

  • *Test their hormone levels to detect and correct imbalances linked to symptoms.
  • Follow up with a natural hormone friendly physician
  • Lose weight as needed. Fat cells contain aromatase, an enzyme that robs the male body of available testosterone by converting it into estrogen.
  • Stick with a program! A low glycemic Mediterranean style diet that's high in protein and fiber and low in fat and carbs can help rebalance hormones and assist weight loss
  • Throw out testosterone robbers like caffeine, alcohol, cigarettes, and unnecessary stressors like burning the candle at both ends day in and day out etc.
  • Take up strength training or weight bearing exercise to boost testosterone and DHEA levels naturally by building up lean muscle mass
  • Counteract stress (the higher the stress levels, the lower the testosterone) with regular exercise – 45 minutes is optimal but even 10 mins. 3x a day adds up to 30 minutes and that is GOOD
  • St-r-e-t-c-h and breathe deep to release tension held in the muscles and lower stress hormones that deplete T levels
  • Hit the sack earlier – less than 7 hours of sleep disrupts appetite hormones to increase cravings and feelings of hunger
  • Take time to do the things you enjoy! Stress reduction is the key to normalizing cortisol and T levels   
*Topical supplements rubbed into the skin (gels, creams) do not always show up in a serum test and can lead to possible OVER supplementation. This is why so many physicians test hormone levels in saliva or dried blood spot sampling to track and adjust dosage as needed.

The good andropause

I encourage you to read the Atlantic article with the awareness that hormone balance never boils down to just one hormone! Getting to the land of optimal health and aging is about getting ALL key players – estrogen, progesterone, testosterone, DHEA, cortisol, thyroid – working together in sync! Just like the symphony orchestra, if one instrument is out of tune, so goes the melody…hormones are your internal symphony.  Replacement has its place as long as it is in tune with your body’s natural rhythms and need for proper care, feeding and rest during andropause!

ZRT Laboratory BLOG Posted by Candace Burch

Monday, April 25, 2016

RSVP-ASAP!!! MAY 2016 YOUniversity Session "Cosmetic and Aesthetic PRP Therapy"

The YOUniversity sessions have been a BIG hit.

Last month's HORMONE's and HEALTH session was a packed house and we want to continue with more information on what's happening inside Providence Medical Spa. Our multi-disciplinary team of healthcare and aesthetic professionals is committed to bringing you the best and most current advancements in Anti-Aging, Skin, and Wellness Care.  The list of services continues to grow and expand as we respond to the requests of clients seeking various options in their anti-aging healthcare journey.

 *****PRP (Platelet Rich Plasma) is the latest addition to the line-up of services inside the MedSpa and we want to offer YOU an invitation.

PRP Therapy?!?!   Really?!?!  That's right!!  NOW available in Branson MO at Providence Medical Spa. It is our pleasure to tell you ALL about PRP by hosting another YOUniversity event.

What is PRP? 
What can it do for your collagen production and the appearance of your skin? 
What does it cost to have it done? 
Are there other options to go along with PRP? 
What can you expect?

This is your invitation to get a behind the scenes look at PRP along with all of the other services our team provides inside the MedSpa.

 Is it time for a Hydrafacial
Are you interested in hormone testing and bio-identical hormones
Do you want an individualized vitamin and supplement regimen because you're just not sure what to take?
Do you want to have a skin tightening session with the Venus machine?
Have you been wanting eyelash extensions or permanent make-up

Providence has it ALL!!  Come check us out by attending this FREE event inside the Spa Conference Room.   See details below and get registered by calling 417-334-4032
Join us May 12th, 2016 @6pm

 Make plans, bring a friend, but remember to RSVP-ASAP!  Our team wants to be prepared for your arrival with resources and information to answer all of your questions.

......and HINT HINT….we give discounts and special offers to those that attend these special programs.  We hope you can join us at the next YOUniversity!

Thursday, April 14, 2016

Testing Hormones 101

Saliva Testing of Hormones and Cortisol
Estrogens, progesterone, testosterone, DHEA-S and cortisol are routinely measured in saliva. Steroid hormones in the bloodstream are mostly (95-99%) bound to carrier proteins, and in this form are unavailable to target tissues. Only the unbound fraction freely diffuses into tissues, including the salivary gland. Hormone levels in saliva therefore represent the quantity of the hormone that is currently available to target tissues and actively exerting specific effects on the body.

Often I'm asked how to go about testing for hormonal imbalance.  It's so simple and affordable and such a life changer for those struggling to make it through their days.  And if you can't make it through your days, how will you ever make it through your years?  Simply click on the link above to find out more about the testing kit that I can provide conveniently by shipping it to your home address. The same kit is used for both women and men and a simple call to our staff can help you determine which testing panel is best for you and your symptoms.  417-231-4544

So is Hormonal Imbalance Affecting You?  If you see any correlating symptoms to what you are personally experiencing, it's probably a good idea.

Loss of pregnancy/miscarriages
Erectile Dysfunction
Night sweats
Sexual dysfunction
Difficulty losing weight or gaining unexplained weight
Vaginal Dryness
Yeast Infections
Continual infections and immunity issues
Memory concerns
Lack of focus
Loss of stamina
Loss of muscle mass
Feeling intensely agitated
And more.......

 Don't put testing off another day.  What you have accepted as "normal" may not be "optimal" for your health, wellness, vitality, and longevity. 
Let's test and assess your individual needs.  For  private appointments 417-334-4032

 To your good hormone health,
Dr. Sonja

Wednesday, February 10, 2016

YOUniversity March 2016: "Hormones and Health" Limited Seats RSVP Early

The March 2016 "YOUniversity" session is set for March 10th, @ 6PM  inside Providence Medical Spa, Branson MO.    This will be a limited-seating/RSVP session and will include a presentation on HORMONES and HEALTH.   Register early and don't forget to tell a friend!! 417-334-4032

This is a **HOT** topic program and you won't want to miss this special opportunity to gain information on the important role of hormones and their connection to health, wellness, weight management, and longevity.  Are you having symptoms?  Are you seeking answers and options in hormone therapy?  Have you had or are you facing a hysterectomy?  Are you having issues with menstrual cycles? Are you feeling hot, tired, anxious, irritable, or not quite yourself lately? Are you living in a brain fog?   Do you simply want to know how to test your levels and what restoration therapies are best for you?  If you answered yes to any of these, then this special YOUniversity wellness session is something that you won't want to miss.  **Remember to follow this BLOG each month regarding future YOUniversity topics and events with our team of medical professionals and aestheticians inside Providence Medical Spa.  We intend to help you live, look, and feel better, longer by sharing key information along your health and wellness journey.  Don't miss out and make sure to check back often!!

About the Presenter:
Sonja O’Bryan, Pharm.D., received her Bachelor’s degree from St. Louis College of Pharmacy and her Doctorate from the University of Arkansas for Medical Sciences.  She also is a Board Certified Healthcare Diplomate, with the American Academy of Anti-Aging Medicine and uses natural, complimentary, pharmaceutical, and integrative approaches in her expertise with patients and their personal needs.   She can be found  customizing therapies inside the Compounding Lab at Lakeland Pharmacy in Branson MO, or inside her office @ Providence Medical Spa providing personal and private consultations. (click on compounding tab) or

After personally visiting with and evaluating each patient, Dr. O'Bryan customizes a plan, provides professional supplements, and coaches them to personal success.   She also offers testing, evaluation, and treatment of hormonal and thyroid imbalance which is a special niche that Dr. O’Bryan uses in helping women and men to look better, live better, and feel better.  In her book, “Living Hormoniously: A Hormone Handbook for the Everyday Women”, Dr. Sonja exposes the real life issues of the day with stories of women going through the changes of “The Change.”  Every woman, no matter her age, can find useful information to help them in their time of need by reading and taking personal notes in her book.  

Dr. O’Bryan also consults with patients on customized therapies for a host of other conditions such as psoriasis, Alzheimer’s disease, wounds, fatigue, stress, pain, gastrointestinal issues (Crohn’s, IBS, diverticulitis), rashes, anxiety and depression, and conditions associated with cancer.  She works closely and directly with physicians, nurse practitioners, chiropractors, and naturopathic physicians using her knowledge and experiences of the past 25 years to formulate customized therapies for specific needs.  To her colleagues, she is known as a practical, ‘go-to’ resource with out of the box ideas and options for health and healing. This while maintaining integrity and high standards in the regulatory scope of her professional practice as a pharmacist/consultant and medicine designer.  ~Catch Dr. Sonja O’Bryan’s Facebook page to stay tuned to updates and information in the Anti-Aging and Hormonal Imbalance World under 'Sonja Pinnell O’Bryan'.

Monday, February 8, 2016



Posted by Dr. Alison McAllister on Wednesday, 20 January 2016                                                                                                                          

Hyperinsulinemia vs Hyperglycemia - the story of PCOS and Obesity             

Hyperinsulinemia vs Hyperglycemia with PCOS and ObesityMany times when I am talking to a practitioner about a patient with PCOS and/or weight issues, I commonly get the response – "His/her blood sugar is normal." However, when we are looking at the health of PCOS and weight-challenged patients, their insulin response is of primary importance, and not just their blood sugar.
When we are fasting, both blood sugar and insulin levels should be at a steady state. Blood sugar is generally between 70-90 mg/dL and insulin levels between 1-8 ┬ÁIU/mL. When we eat a meal, blood sugar increases. In response, insulin is produced by the pancreatic beta cells to help shepherd glucose into all cells to be used as energy. Within 2 hours, insulin and glucose levels should have essentially returned to normal. Thus, our cells’ exposure to glucose and insulin is only for short blips of time within a 24 hour cycle. Excess glucose that is not used for energy is stored as glycogen in the liver and muscle cells to be used for energy between meals, where it is rapidly available for sudden energy needs such as "fight or flight" situations; but once these stores are full, the body stores extra glucose as fat in adipose cells and we gain weight.

Thursday, January 28, 2016

MTHFR: Is This YOUR Missing Link?

This is one of those blogs that could seriously help a lot of people.   First take a look at this list of conditions, consider some of the things you know about yourself or someone you love, and read more on this topic.  Maybe it will open up some discoveries in your healthcare plan that you have never considered before.

Do you have one of these conditions?

Infertility (Male and Female)
Frequent Miscarriages
Heart Disease
Multiple Sclerosis
Breast Cancer
Chronic Fatigue
Irritable Bowel Syndrome
Cervical Dysplasia
Elevated Homocysteine
Bipolar Disorder
Peripheral neuropathy
Restless Leg Syndrome

Now ask yourself these questions:   Am I on a "medication" to treat a problem on this list? Could my families risk with heart disease and cancer be linked to something more? I know I'm just not feeling my best, is there something missing in the details of my wellness quest? Can I do something to help support my system with the diagnosis I've been given?   If you answered yes, then this blogs for YOU!  Read on......Here's information that you may have never read about and that is VERY important to know.  

Methylation is a vitamin-requiring biochemical process in the body that is critical for supporting mental and physical health, including the regulation of gene expression.  Methylation is required for energy metabolism, immune and nerve cell function, fertility and sustained pregnancy, detoxification pathways, cardiovascular health, mood support and the regulation of neurotransmitters (think depression and anxiety and insomnia), and MORE. The correct function of the methylation cycle is dependent upon a number of key enzymes but a main enzyme one is 5,10 methylenetetrahydrofolate reductase (MTHFR). Some people have a genetic defect in the function of this enzymatic process which inhibits their ability to convert and produce active forms of folate.  5-methyltetrahydrofolate (5-MTHF) is a biological form that is absorbed at the gut level, and transported across the blood-brain barrier, which offers incredible health and wellness benefits to your entire body.   So consider this. Does your body methylate properly?  Is your genetic mapping skipping a beat due to a problem with how your body converts your food and supplement sources to active folate?   Maybe so!

Ideally, a person should be able to absorb folic acid from foods and dietary supplements and convert them to the active form of folate to make all of the necessary body processes go smoothly.   I wanted to sound an alarm through this blog because research and clinical evidence is showing that this genetic determinant and link to diseases may be worth paying more attention to.    AND, there's a strong thread of prevalence in families for this  problem.  Is there more connected to that fibromyalgia diagnosis you've been given?  Are your sleepless nights because you're not "methylating" appropriately to convert serotonin and melatonin.  Has fertility and pregnancy been a concern? There is a common genetic mutation in the general population which reduces MTHFR significantly and can predispose these people to various conditions like those indicated in the list above.

Get this!!  Numerous studies have connected folate deficiency with depression.  In patients that are folate deficient, the response to antidepressants will be less than optimal compared to those with normal folate status.  Now think about that.  Have you been on an antidepressant for anxiety or depression without ever knowing your methylation and folate status?  The answer is probably yes to that too.  I'd suggest you do some reading and perhaps open up a discussion with your physician about "MTHFR deficiency" and the lab tests to find out. 

Who should consider a screening for MTHFR mutations?  (not all inclusive)
Those with mood disorders such as depression, anxiety, irritability, mood swings, bipolar disorder.
Infants and children of parents with MTHFR mutations
Family members related to someone with MTHFR mutations
Infertility or Pre-conception care (both MEN and WOMEN)
Elevated folate
Elevated homocysteine
Elevated serum cobalamin (due to the inability to methylate cyanocobalamin to methylcobalamin)
Patient with syndromes such as : IBS, fibromyalgia, chronic fatigue, downs syndrome
Alzheimers, Parkinsons, Autism, Epilepsy
Family history of cancer
Cervical dysplasia
Cardio disease (strokes, heart attacks, clots, high blood pressure)
Birth Defects

Other Nutrient Deficiencies Are Important too!!
Other B vitamins are very essential in looking at this whole process. 

B12, specifically Methylcobalamin the most active 'methylated' form, works along with folate in regulating pathways and processes in our body.  B12 is considered to be a VERY important nutrient in balancing homocysteine levels.  An elevated homocysteine level is not a good thing and if there's heart disease in your family, it's worth getting evaluated with your doctor.  ***Vegetarians and the elderly run the highest risk of a B12 deficiency.  Remember, Methylcobalamin is what to look for in a supplement.

Biotin, synthesized by the bacteria in the gut in addition to certain foods and cofactors are involved in metabolism of fatty acids, amino acids and proper utilization of B Complex support formulas.  Over-processed grains and simply cooking out the nutrients in our foods can cause depletions of these key factors in our diet resulting in sluggish energy and poor oxidative benefits.  Biotin is good for the hair, skin, and nails also. 

Niacin (as Niacinamide) is a cofactor in the mitochondrial respiratory chain which produces cellular energy. Niacin (or nicotinic acid) has a long history of use in cardiovascular health.

Vitamin B2 (riboflavin) helps support healthy blood pressure. Studies indicate that homocysteine levels in individual with certain MTHFR mutations are very sensitive to riboflavin status. 

Vitamin B6 is involved in over 100 enzymatic reactions in the body and is essential for lipid metabolism, neurotransmitter formation, immune health, and hormone processing.  The really big issue with B6 when it comes to this topic is that it is essential in methylation for the breakdown of homocysteine.  Again, an elevated homocysteine level is a common marker that is evaluated for heart disease risks.

Trimethylglycine (Betaine)
 As a methyl donor, this key nutrient supports liver function and helps with detoxification pathways. There's evidence to show that it is beneficial in protecting against fat accumulation in the liver but it also helps work in harmony with the "B" list of vitamins that I mentioned above. 

 I can promise you that one of the BIG questions I ask when working with someone to evaluate their supplements and wellness regimens is, "Are you taking a B Complex Support Formula?"  And on that note, let me just tell you that not all B Complex formulas are created equal.  I believe in using pharmaceutical grade and high quality products in the most absorbable forms to the body.  Take a look at what you are currently using (if anything) and see if some of these key essentials are in your product.  If not, call me and I can help guide you to a good option.

Again, let me just reinforce the importance of this information and taking a look for yourself.  Revisit the list of disease states and some of these conditions and do some homework.  Are you dealing with symptoms that might have an explanation which was never evaluated or detected (MTHFR)?  QUITE POSSIBLY!!! Just in general, can you do something to help support your system?  ABSOLUTELY!  Re-evaluate your supplements, this list, and determine if you need to get some additional checks with your doctor.

"B" Well !!!

All the best,
Dr. Sonja