Heart Health and You- Part 2- Exercise!

How strong is your heart? The healthy heart can produce enough energy in an hour to lift a one-ton car off the ground, and accumulate enough pressure to squirt blood at a distance of 30ft! Although most of us would like to think that our own heart has this ability; it’s not usually the case. In fact heart disease is the number one cause of death in the United States today with a whopping 599,413 deaths per year. This number is especially concerning because although some people are more genetically inclined to develop a cardiac illness, for most of us it’s 100% preventable. Earlier this month, we discussed the many different foods and beverages that will aid you in your journey to becoming heart healthy and in this second installment, we will be providing some simple and effective exercises that you can utilize in combination with your new and improved diet.

For most of us, getting regular exercise seems like a chore with no gratification. The idea of pain, sweat and tears without the instant gratification of seeing results isn’t very appealing when deciding whether or not to leave the comfort of your couch. However, any moderate-intensity exercise like swimming, jogging, Pilates or yoga is excellent for your fitness without feeling like you’re going to cough up a lung. Exercising your heart muscle means exercising your body: no need for a gym, just a bit of motivation and a good pair of walking shoes. If you “don’t have time” then fit shorter but more frequent periods of time, like 5-10 minute intervals several times a day throughout your day. Take the stairs, park your car further away from the door, and definitely count in those house chores such as mowing the lawn, vacuuming, or a short brisk walk around the block at lunch or for a break. The gaming console Wii also has several fun games such as Wii Sports or Wii Fit Step Aerobics – which is great exercise you can do with your kids-make it a family affair.

For adults that are 65 and older or anyone with chronic conditions or limited mobility, you still need the same amount of exercise as younger people but the activity can be less intense. Practice balance exercises to help prevent falls and injuries. Balance techniques are used frequently as exercises in yoga or more simple forms of balancing exercises such as walking heal-to-toe, standing on one foot, or standing up and sitting down without using your hands. Use good judgment and follow your doctor’s advice.

When these components are combined with a healthy diet, the outcome will hopefully be a much healthier heart and surely a much longer life. These tips make choosing to live a heart healthy life an accessible and reasonable goal to work towards so get started today! You are responsible for the health of your heart and the health of your life! Get the support of your family and primary care provider and get that blood pumping!

Part 2 of our February blog was written by Dania Abdul-Resoul, an intern at avecinia wellness center.  Dania is a pre-physical therapy student at Cal State Fresno.


For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page and follow avecinia on twitter . avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Your Heart and You- Celebrating the Heart in American Heart Month

Ahh February a time for couples to bask in their love for each other and a time for singles to bask in their love for chocolate. However, no matter your current relationship status, February is also American Heart Month. No need for roses or a box of sweets for this holiday, just the simple act of staying heart healthy and acknowledging the importance and well-being of this organ is more than enough. So before we start talking about treatments and prevention, let's take a little time to get to know what the heart actually does.

Every day your heart beats approximately 100,000 times, sending 2,000 gallons of blood surging through your body. Although it's no bigger than your fist, your heart has the mighty job of keeping blood flowing through the 60,000 miles of blood vessels that feed your organs and tissues. However, even when put into this perspective, the allure of fried foods and choosing to stay at home on a rainy day instead of going to the gym is far too strong for most of us to handle. So instead of completely uprooting your life style, read the whole blog for some simple and easy tips to ensure that your heart continues to do what it does best.

When it comes to your diet there are a number of specific foods that will benefit your heart over others. When looking at meat, Salmon and Tuna are always healthy alternatives packed with plenty of Omega 3 fatty acids. Omega 3 aids in reducing the risk of heart disease and stroke while helping to reduce symptoms of hypertension, depression and attention deficit hyperactivity disorder (ADHD). Brown rice is loaded with B- Complex vitamins which improves mood, gives you healthier skin and helps with immune and nervous system function. Brown rice is also an excellent substitute for white rice and bread. Of course all vegetables are healthy for you, but there are some in particular that will give your heart that extra boost. Vegetables such as: carrots, spinach, broccoli, sweet potato, acorn squash, red bell peppers and asparagus all provide many antioxidants and vitamins that help reduce blood pressure and strengthen the heart as a muscle. Similar to vegetabels, fruits also have the same nutritional value when it comes to staying heart healthy. Blueberries, pomegranate, kiwi and red grapefruit all provide a wide range of natural blood thinners, isoflavones, and help reduce the LDL (bad cholestrol) levels and raise the HDL (good cholestrol). Red wine containing polyphenols which help protect against cell damage, tea and soy milk are great when choosing beverages. Dark chocolate that is 70% or higher in cocoa provides you with something to sweeten your taste buds and keep you healthy!  Dark chocolate contains a large number of antioxidants (nearly 8 times the number found in strawberries). Flavonoids  help relax blood pressure through the production of nitric oxide, and balance certain hormones in the body.

Making small changes in your eating habits is the first step to becoming heart healthy. Utilize the tips we have provided and pace yourself so the body has time to adjust. Stay tuned for part 2 of this blog after February 14th where we will discuss the different types of excercises that will strenghten your heart without putting a strain on your body.

Our February blog was written by Dania Abdul-Resoul, an intern at avecinia wellness center.  Dania is a pre-physical therapy student at Cal State Fresno.


For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page and follow avecinia on twitter . avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Obesity in Fresno and You!

The Central Valley has the highest overall rate of obesity in California (See Prevalence of Obesity amongst Adults Age 18 and Over) and almost 1 in 3 kids in California are overweight or obese.   Obesity amongst minority (ethnic and socio-economic) children is even more rampant.  The cost of obesity, to families, employers, the health care industry and the government is approximately $21 billion (Obesity and Diabetes: Two Growing Epidemics in California, UCLA Center for Health Policy Research, August 2010).  Without serious efforts to address this growing epidemic, there may be no turning back. 

It will take a collective effort, the effort of health care providers, parents, children and the community to start making a difference. The following are examples of things parents and children can do, health care providers and the community can do and an example of something being done right here in Fresno!

Parents and children:

Parents are the biggest influences in their children’s lives. As a parent, you have the power to turn off the TV, select what you and your family will eat, structure how you will spend time with your kids and be healthy role models.  Start with:

• Let your kids let it out, the energy that is.  Get your kids to play, run around, be physical for at least an hour a day. Avoid using restriction of play as a disciplinary measure;
• Turn off the tube.  Not only does TV time decrease play time, the “foodless fridge” also inundates your kids with marketing for sugary snacks and other unhealthy food;
• Get them to bed.  Create a sleep friendly environment and habits. DO NOT PUT A TV OR COMPUTER IN THEIR ROOM.  Have quiet time before bed time.  Talk to your doctor about including safe, natural sleep supplements such as melatonin in your diet.  Studies show that children and adults who sleep less than 8 hours have higher levels of hormones that make you feel hungry and lower levels of hormones that make you feel satisfied; and
• Use the kitchen as family time by cooking healthy meals with your kids.  Not only will the family save money by not eating out, you can eat healthier, teach your kids good habits and bond with them all at the same time.  Who knows, you may even inspire the next Martha Stewart or Emeril!

The community and you:

The community you live in is a reflection of you.  Unfortunately in Fresno and the Central Valley, we have the highest rate of obesity and diabetes in California.  Studies indicate that higher rates of obesity and diabetes impact poorer areas more than wealthier areas.  This can be due to more restricted access to gyms, inadequate food choices, and lack of health care. 

However, the lack of financial resources cannot be an excuse.  Here are some ways you and your community can work together to combat obesity: 

• Here in the San Joaquin Valley, we have access to beautiful, natural gyms- our vast amount of parks, trails and other places to be physically active.  Go for a walk with a loved one, make sure you wear sunscreen;
• If a park is too far or it’s too hot, the community should ask for local schools to be open during the weekend so gyms can be used to hold free fitness classes.  For example, a local business can sponsor a trainer to hold 30 minute aerobic classes on the evenings and/or weekends; and
• Local government can help by restricting the number of permits for fast food restaurants in low-income neighborhoods and incentivizing more grocery stores or farmers markets to locate within those same neighborhoods.   Sometimes people need help in making better choice.

Local business can work with the community to promote healthier living.  That’s what we are doing.  Recognizing the severity of the obesity epidemic in the Central Valley, avecinia wellness center (www.avecinia.com) partnered with Marjaree Mason Center (“MMC”)  (www.mmcenter.org) and donated the services of Registered Dietician Sunny Yingling, MS, RD to develop a nutrition program for MMC clients.  The MMC serves over 86,000 meals, with more than half going to children, children who statistically are more likely to be or become obese. The program helps the MMC pick nutrient dense food items for its clients who then use recipes learned in classes taught by Sunny to bond with their children over meal preparation.  This past June, we partnered with Granville’s Sageberry grand opening to raise money and awareness about childhood obesity and the nutrition program. Through the nutrition program, avecinia, other local businesses and MMC are able to make a small, but important, step in the fight against obesity.   If you are part of a local business and would like to know how you can help make Fresno better, feel free to contact Aamer Hayat at aamer@avecinia.com.

For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!

Heart Healthy for American Heart Month

Heart Health

From the beginning of time, the heart has held, well….. a special place in our heart. The ancient Egyptians believed the heart was where the soul lived, where wisdom came from, where memory was stored and where emotions sprang forth.  It was considered the most important of the body’s organs.   The ancient Greeks had similar beliefs about the heart.  Yet now, cardio-vascular disease is the number 1 cause of death globally (approximately 29% of all global deaths http://www.who.int/mediacentre/factsheets/fs317/en/) and the leading cause of death for both men and women in America.  In 2006, more than 1 in 4 Americans   died of heart disease.  In 2010, heart disease cost the United States approximately $316.4 billion in health care services, medications and lost productivity.  In California, the leading cause of death (35%) is due to Heart Disease and Stroke.

 

However, just as the ancient Egyptians and Greeks valued the heart, you can too.  February is American Heart Month and it’s the perfect time for a heart tune-up! Our health blog this month will help you recognize the risks and symptoms of heart disease and give you simple, easy to follow tips to help you become heart healthy! And if you are planning on being at the Central Valley Go Red For Women Fashion Show and Luncheon (Friday, February 11, 2011 https://ahafresno.ejoinme.org/MyEvents/20102011CentralValleyGoRedLuncheon/tabid/234136/Default.aspx) stop by our booth to say hi!

Risks

High cholesterol, high blood pressure, diabetes, cigarette smoking, elevated Body Mass Index or BMI (overweight or obesity) and physical inactivity are major risk factors for heart disease.  The best way to mitigate all of the risk factors for heart disease is by addressing elevated BMI  (being overweight/obese) and your first step in addressing that risk is by… well, taking a few steps.  Reducing your weight by just 10% can significantly decrease your blood pressure, lower your blood cholesterol and reduce your risk of diabetes.

   

Symptoms

It can be difficult to “catch” cardio vascular disease because the build-up of cholesterol or rise in high blood pressure is usually gradual.  It is usually at the time of an event (such as a heart attack) that a person knows they have a disease. The most common symptom or sign of cardiovascular disease is angina or chest pain. You may feel tightness, burning, or swelling in your chest with angina.  However, these symptoms can also occur with heartburn, so you must consult your health care provider if they occur.  If you are also having heart palpitations, dizziness, nausea and excessive sweating, it is more likely to be a cardio vascular event such as a heart attack.

During a heart attack, symptoms may last 30 minutes or longer and are not relieved by rest or oral medication.

To learn more and print a handy symptom guide, visit Mayo Clinic’s Heart Disease Symptom Guide.

If the symptoms are severe, immediately call 911.

Prevention - So how do you get started on a heart healthy lifestyle?

1.       First, speak with your primary care provider about your concerns! 

a.       At avecinia wellness center, we have a strong history of addressing our patient’s heart health issues and can work with you to develop a heart healthy plan.  We also partner with other great health and wellness providers, such as Fitness Studio 108, to help you get the most comprehensive attention to your heart;

b.      We offer many resources on our website and facebook page.  You can also log on to your Patient Portal and research any of the questions you may have.

2.       Use the web to learn more!

a.       If you don’t know where to go, visit our “Your Health” link on our Facebook page for a list of trusted resource.

b.      Or  visit one of these health related web resources:

                                                                   i.      The American Heart Association’s Tools for Your Heart Health site

                                                                  ii.      The Centers for Disease Control and Prevention Heart Disease site

                                                                iii.      The Mayo Clinic Heart Disease site

                                                                iv.      The California Heart Disease and Prevention Program site

c.       Use the web to track your progress. Keeping a log is a proven way of remembering where you started, how you’re doing and measuring  your success.  The American Heart Association has a several different progress trackers here.

3.       Get your friends and family involved!

a.       The more, the merrier. Having the support of friends, family and loved ones makes it easier to overcome any challenges and more fun to celebrate the achievements!

                                                                   i.      Take a 30 minute family walk together at least every other day.  Use the time to unwind, connect, and encourage family fitness.

                                                                  ii.      Cook dinner together.  Having more meals at home saves lives and money -Food at restaurants usually have higher fat content and portions are much larger than necessary.  Cooking at home allows you to control the amounts of fats, oils, and sugars used.  It’s also a great way to learn and teach healthy eating habits.  Here’s a great link to heart healthy cooking:  WebMD

                                                                iii.      Share your plan with your family.  Let them know you are serious so they can help you on the difficult days and keep you on track.

Ready to get healthy?

We recognize it may not be easy to take the first steps necessary to live a heart healthy life. But it’s not impossible.  To see how incorporating physical activity and a healthier diet can change your life, view this report by Christina Lusby of KSEE 24 on Bob Tharp.  Bob lost over 80 pounds, has his diabetes under control, and is saving $500 a month all by incorporating physical activity and a proper diet into his routine with the guidance of avecinia wellness center.  Bob and avecinia are now working on developing a diabetes management support group for Fresno and Central Valley residents. We plan on having our first, free meeting in March!  To learn more about our program or join the mailing list, email us at wellness@avecinia.com with Diabetes Support Group in the subject line.

Get started today though by at least having an honest conversation with yourself, your loved ones, and your primary care provider on why you want to become heart healthy!

Top “Five” Fitness Tips For The Holiday’s!

Annie Malaythong- Health Coach Studio 108

Holiday season is here! With family gatherings and holiday parties filled with baked goods, foods and alcohol it’s hard to stay on track. Let’s face it; we all worry about putting on “winter weight.” But what exactly are we doing about it? It’s time to be realistic. It would be a shame for you not to enjoy your family and friends and all the goods. So, let’s set realistic health and fitness goals to keep you on track! Here’s to a healthy 2010 and to a better 2011!

1. Realistic Fitness Action Plan- Write out a “top 3” daily “Active To-Do” list to keep you feeling accomplished and productive with your fitness. Again, emphasize the “realistic.” If you currently are doing nothing for your fitness here’s an example:
1. Walk for 15 minutes today. (Anywhere)
2.  Stretch for 5 minutes.
3. Perform 3 different exercises that you are confident with.
2. Spice it up! Spicing up your workout can do wonders for your mind and body. Try doing something different. Studio 108 in Fresno offers unique classes such as Thai Budokon, Self-Defense Classes, Mind/Body/Stress-Free Yoga, or (30 minute) Express Cardio Intervals. If you’re not a group exercise person, try a personal trainer or a fitness specialist to mix it up. Mixing up your workouts and spicing it up will keep you motivated throughout the holidays and keep your body guessing. This will result in a longer fat burn
3. Easy on the Alcohol -Alcohol consumption packs on additional calories. Think of every 8oz alcoholic drink as roughly 30 minutes of additional cardio.
4. Understand your Calories IN vs. Calories OUT- Check out your BMR (Basal Metabolic Rate). The number of calories you’d burn if you stayed in bed all day. That number represents how many calories you need to consume just to maintain life without working out or being active. If your calorie intake is more than calories being burned, you are more than likely progressively gaining weight. Staying active is the key!
5. “Cheating” moderately- We all know sugar, sugar and sugar is the main ingredient for the holidays. If you can’t stay away or are tempted, try keeping your sugar intake to a minimum. A great trick is to fill up your sweets in the palm of your hand and limit choices to one “sweet palm” for the whole day. Example:

• “I have choices of apple pie, cookies, toffee, pumpkin pie, etc...”
• “I can only fit 2 pieces of toffee, and ½ of a pumpkin pie in the palm of my hand. I will limit my sweets to only these two options for the WHOLE day.
• “I will not attempt to stack, mash, crumble, combine or overflow my palm. For every additional serving of a “sweet palm” is another 1,000 calories which is roughly two hours of cardio for an average 150lb person. Or for every three “sweet palms” is one extra pound of pure body fat. “ * Eating balance meals focusing on macronutrients will avoid cravings and keep you feeling full longer.*

Moderation, balance and keeping active are key to a healthy you. Setting realistic goals, using some or all of the steps above, is a great way to start and stay on your fitness and well-being plan.  Share it with your family and friends so you don't have to do it alone!  Happy holidays and Happy New Year!

This blog was written by Annie Malaythong, Health Coach, Fitness Studio 108.  Annie is owns Fitness Studio 108 and was previously the Director of Fitness at Gold's Gym (Central Fresno).  Annie is a spokesperson and Nutrition Specialist for "Run For The Dream" Project Child Obesity Campaign, has been on KMPH 26 and KSEE 24 and can be seen beginning December 29th on MTV's "I Used To Be Fat".   avecinia wellness center works with Fitness Studio 108 to help our patients achieve their optimal well-being.  Our individual weight loss and management program incorporates fitness and nutrition provided by experts at Fitness Studio 108.  To learn more about avecinia wellness center and Fitness Studio 108's weight loss/management program, visit www.avecinia.com

avecinia wellness center is Fresno's premier integrative medical and wellness center. We combine primary care with health management, weight management, acupuncture, massage therapy and aesthetics to provide a holistic approach to your health and well-being.  We use a state of the art electronic health record program and patient portal (by athenahealth) to help deliver our unique services to our patients. Learn more by visiting our website at www.avecinia.com or "like" us at www.facebook.com/avecinia or follow us on twitter at www.twitter.com/avecinia4health

The Basics to Weight Loss

The Basics to Weight loss
It takes a lot of effort and commitment to make healthier lifestyle changes, especially when it comes to eating habits and exercise. It is best to ease into new habits slowly. Overtime, this healthy lifestyle will help you look and feel better, not to mention have a healthier heart. A good place to start is with what you eat!

A well-balanced diet is one that delivers an adequate amount of calories while providing the maximum amount of nutrients. The body breaks down food to release energy and this process is called metabolism. Excess calories, more than your body uses, will be stored as body fat. An increased activity results in an increased metabolism. Unfortunately, the opposite is true. With decreased activity, increased food intake or both, your body will continue to store energy as fat, causing weight gain.
What to do
To lose weight, your intake of calories must be less than your body uses. A pound of fat is about 3,500 calories. To lose 1 pound of fat per week, you have to either eat 500 fewer calories or burn off 500 calories by exercise per day. A combination of the two is the best way to achieve this goal: cut 250 calories from your diet and exercise enough to burn off 250 calories. A healthy amount of weight loss is no more than 2 pounds per week.

Most people benefit if they eat small, frequent meals (about 5 to 6 meals) throughout the day, eating about every 2 to 3 hours. Eating breakfast is important and do not skip meals. Skipping meals may cause you to feel too hungry and overeat later in the day.
What not to do
Avoid fad diets. Most offer short-term changes and can lead to rebound weight gain. To get started on weight loss, keep a record of what you eat and how much exercise you get each day. You will be surprised on your habits. Find an eating plan and exercise regimen that works for you and slowly get comfortable with positive habits. Remember, good health comes from long-term effort and commitment.
Food choices
Eat a variety of colorful, nutrient rich fruits and vegetables. Frozen vegetable can offer a cost-effective choice without sacrificing nutrients.

Since fiber often makes you feel full, include an adequate amount of fiber in your diet. Fiber can be found in green leafy vegetables, whole grains, beans, fruit, nuts and bran flakes.

Eat three servings of low-fat or fat-free dairy daily. Milk, yogurt and cheese are good sources of calcium and Vitamin D.

Think of meat as a side dish. The serving size should be equivalent to the size of your palm or a deck of cards. Choose lean meats, skinless poultry and fish rich in omega-3 fatty acids.

Avoid consuming foods high in saturated and trans fats. These may cause in increase in LDL cholesterol (“bad” cholesterol) and increase your risk in heart disease.

Remember that some fats are beneficial to your overall health. These “good” fats are polyunsaturated and monounsaturated fats found in nuts, fish and low- or nonfat dairy products.

Avoid foods that are referred to as “empty calories.” These foods add lots of calories to your diet without having much nutritional benefit. Examples include soda, fruit drinks, fruit juice, sports drinks, energy drinks, sweetened tea and flavored or sweetened milk.

Canned foods tend to be high in sodium, so buy reduced-sodium or no-added-salt versions. Thoroughly rinsing canned beans can reduce the sodium content by 40%.
Healthy Tips on Dining Out
•Ask about low-fat choices
•Avoid fried appetizers or creamy soups
•Avoid high-fat items on salad such as cheese, bacon bits, croutons, chopped egg, olives and creamy dressing
•Make substitutions like steam vegetables, instead of french fries
•Ask for all butter, dressings and sauces to be left on the side; either omit or control how much you use
•Make sure your entrée is broiled, grilled, baked, steamed or poached instead of fried
•Order fresh fruit or sorbet for dessert instead of cake, ice cream or pie
•Removes the skin off poultry or visible fat from meat




For daily updates on news, information and more on health care and wellness, join avecinia wellness center's facebook page (facebook.com/avecinia) and follow avecinia on twitter (twitter.com/avecinia4health). avecinia wellness center is Fresno's premier integrative medicine and wellness center. We combine internal medicine and primary care with health management, weight management, acupuncture, aesthetics (Botox, Juvederm, Radiesse, Obagi and more) and massage therapy for a holistic approach to health. We use a robust electronic health record program and patient web portal to enhance our delivery of services and to help our patients reach their optimal well-being. To learn more, visit www.avecinia.com. If you are looking for a primary care doctor in Fresno or the Central Valley and would like to become a part of the avecinia family, visit our website and click on new patient registration. Let Dr. Unaiza Hayat and/or Ali Kunkel, MPA, PA-C, become your trusted guides. Our Aesthetic, Weight Management, Acupuncture, Health Management and Massage Therapy services do not require us to be your primary care physician. Learn more at www.avecinia.com We look forward to meeting you!