Is it a Cold or an allergy?

Is it a cold? Or allergies? If your runny nose and sneezing linger for more than a week or two, there's a good chance it's allergies. If you have allergies, your immune system, your body's defense system against bacteria and viruses, is on overdrive. It's reacting to a normally innocuous substance such as pollen, trees, grasses or ragweed as if it's a foreign invader. Often, it's bugged by more than one thing such as pollen, dust mites, mold spores, pet dander, or even food.

In order to defend the body, the immune system produces antibodies called immunoglobulin E, or IgE. These antibodies attach to the body's mast or tissue cells and basophils, or blood cells. When an allergen like pollen encounters its unique IgE, it fits like a key into a lock and releases histamines that result in inflammation and all the uncomfortable symptoms of allergies like a runny nose, sneezing, nasal congestion, itching, rash, swelling, and even asthma.

If your parents are allergy prone, you may be too. Or you can develop them when your resistance is low when you’re under stress. The most common substances that can provoke seasonal allergies in Colorado include: Trees such as Elm, Cottonwood, Cedar, Juniper, Pine and Aspen. other plants such as ragweed, pollen, thistle, dust and sage.

Other substances that can provoke an allergy include: Nickel, cosmetics, lanolin, animal dander, dust mites, some common drugs such as penicillin, aspirin and sulfa drugs, some food additives such as benzoic acid, food colorings and sulfites and chemicals found in soap and laundry detergents.

Many people are allergic to molds. Molds can live throughout the house, under the sink and in the bathroom, basement, refrigerator or any dark and damp place. Mold spores are carried in the wind and predominate in the summer and early fall. Cutting grass, harvesting crops or walking through tall vegetation can provoke a reaction.

Foods can also provoke allergic reactions. Some of the most common allergenic foods include chocolate, dairy products, eggs, shellfish, strawberries, citrus fruits, corn, wheat, peanuts, food additives, preservatives and dyes.

What causes environmental allergies?  Many environmental allergies are caused by food allergies.  When your internal environment such as your digestive tract and immune system is not working very well you develop environmental allergies.

What kind of natural treatments are available for environmental allergies? You can get rid of both food and environmental allergies.  Allergies tend to get worse every year if not treated.  Dr. Wiancek uses homeopathy to desensitize a person from their specific environmental allergies. She also uses natural anti-inflammatory products and Chinese herbs depending upon how severe the reaction. 

What is the difference between a food intolerances and food allergy? A person with a food intolerance is unable to digest and process food correctly, usually due to a lack of a certain enzymes and inflammation in the gut. A food allergy occurs when a person's immune system generates an antibody response to the injected food. Food intolerances can lead to an allergy, if particles of undigested food manage to enter the bloodstream and cause a reaction.

What are the most common symptoms of food allergies?  There are many symptoms related to food allergies these include:

Recurrent colds, sore throats, chronic tonsillitis, ear infections, ringing and buzzing in the ears, chronic nasal congestion, postnasal drip, Meniere's syndrome, constipation, diarrhea, abdominal cramping, ulcerative colitis, gallbladder disease, irritable bowel disease, migraines and other headaches, hives, canker sores, psoriasis, eczema, acne, asthma, frequent urination, teeth grinding, bedwetting, colic, muscle aches, osteoarthritis, rheumatoid arthritis, unexplained fatigue, anxiety, depression, insomnia, food cravings, obesity etc.

Most of these disorders have more than one cause, but food allergy is a relatively common and frequently overlooked cause. How a food allergy is best diagnosed? Food allergies are best tested thru a blood test.  The skin scratch test is used mainly for environmental allergies and immediate reactions to food.  Most people have delayed reactions to food which can be a symptom happening up to three days after eating an allergic food. A person can become allergic to almost any type of food and any combination of foods. Therefore, an accurate diagnosis is important.

Environmental and food allergies do not go away on there own.  If left untreated allergies tend to get worse every year.  Allergies can be treated successfully by improving your overall immune function, desensitizing a person from environmental allergies, eliminating the allergen, improving digestion and overall intestinal health.

Dr. Wiancek is a naturopathic physician who has been practicing at the Riverwalk Natural Health Clinic & Natural Pharmacy in Edwards, Colorado.  She is an author, educator and practitioner specializing in natural medicine. For questions you can e-mail her at Wiancek@healthref.com or call at 970-926-7606. 

Allergy Prevention Tips

ALLERGY PREVENTION TIPS

FOR THE WHOLE FAMILY

Our environment is loaded with potential allergy triggers. While avoiding the outdoors entirely in the springtime is not feasible, one should aim to limit exposure to pollen and other common airborne triggers (e.g. tobacco smoke) as much as possible. The following tips will help you reduce your exposure significantly:

ü  Wash off pollen from hands & other exposed areas during peak allergy seasons.

ü  Keep windows and doors closed during high pollen count times and stay inside on the driest, windiest days to minimize exposure to seasonal allergens.

ü  Use high-particulate air (HEPA) filters inside to reduce most airborne contaminants, especially in bedroom locations.

ü  In humid areas, use a dehumidifier to limit mold growth.

ü  Buy allergy-proof bedding, including mattress and pillow case covers, to reduce allergy symptoms, and regularly wash sheets, blankets, and pillow cases in hot water.

ü  Stuffed animals and real animals alike can contribute to allergic rhinitis, so wash them frequently.

ü  Consider removing carpeting in bedrooms or use area rugs that can be cleaned regularly.

ü  Vacuum all carpets and floor surfaces weekly with a HEPA-filter equipped appliance.

ü  Remove shoes at the front door when entering the house to limit tracking on contaminants and potentials irritants throughout the home.

ü  Limit lawn-mowing and other gardening activities at peak allergy times; avoid use of chemical pesticides and outdoor products.

ü  Use environmentally – and health-safe household cleaners.

ü  Eat healthy, whole organic foods with plenty of anti-inflammatory antioxidants.

ü  Avoid use of herbal products and food that can cross react with seasonal allergens; for some people this may include Echinacea species and certain fruits and vegetables (this is known as oral allergy syndrome).

ü  To prevent allergic disease in babies, consider perinatal avoidance of known food allergens, especially if there is a family history of atopic disease; breastfeeding is known to be protective as well.

ü  Ty a saline rinse device called a neti pot to clear pollen from the nasal cavities. Even children as young as 2 years old can be taught how to use one.

ü  Look into using specific natural health product supplements, like probiotics and essential fatty acids, which may lower your risk of developing allergies.

ü  Think about taking up a stress-coping technique, like yoga or meditation.

Allergy Season is Upon Us

Allergy Season is upon us. What can you expect?

What is an allergy? An allergy is an inappropriate response by the body’s immune system to a substance that is not normally harmful. In some people, the immune system wrongly identifies a nontoxic substance as an invader, and the white blood cells overreact and do more damage to the body than the invader.

What are common signs and symptoms of environmental allergies? Seasonal nasal congestion, itching, burning eyes, hives, coughing and headaches.

The most common substances that can provoke seasonal allergies in Colorado include? Trees such as Elm, Cottonwood, Cedar, Juniper, Pine and Aspen. And other plants such as ragweed, pollen, thistle, dust and sage. 

Other substances that can provoke an allergy include: Nickel, cosmetics, lanolin, animal dander, dust mites, some common drugs such as penicillin, aspirin and sulfa drugs; some food additives such as benzoic acid and sulfites and chemicals found in soap and laundry detergents.

Many people are allergic to molds. Molds can live throughout the house, under the sink and in the bathroom, basement, refrigerator or any dark and damp place. Mold spores are carried in the wind and predominate in the summer and early fall. Cutting grass, harvesting crops or walking through tall vegetation can provoke a reaction.

Foods can also provoke allergic reactions. Some of the most common allergenic foods include chocolate, dairy products, eggs, shellfish, strawberries, citrus fruits, corn, wheat, food additives, preservatives and dyes.

What kind of natural treatments are available for environmental allergies? Dr. Wiancek uses homeopathy to desensitize a person from their specific environmental allergies. She also uses natural anti-inflammatory products and Chinese herbs depending upon how severe the reaction.  

What is the difference between a food intolerances and food allergy? A person with a food intolerance is unable to digest and process food correctly, usually due to a lack of a certain enzyme or enzymes. A food allergy occurs when a person’s immune system generates an antibody response to the injected food. Food intolerances can lead to an allergy, if particles of undigested food manage to enter the bloodstream and cause a reaction.

What are the most common symptoms of food allergies?  There are many symptoms related to food allergies these include:

Recurrent colds, sore throats, chronic tonsillitis, ear infections, ringing and buzzing in the ears, chronic nasal congestion, postnasal drip, Meniere’s syndrome, constipation, diarrhea, abdominal cramping, ulcerative colitis, gallbladder disease, irritable bowel disease, migraines and other headaches, hives, canker sores, psoriasis, eczema, acne, asthma, frequent urination, teeth grinding, bedwetting, colic, muscle aches, osteoarthritis, rheumatoid arthritis, unexplained fatigue, anxiety, depression, insomnia, food cravings, obesity etc. Most of these disorders have more than one cause, but food allergy is a relatively common and frequently overlooked cause.

How is a food allergy best diagnosed? Dr. Wiancek uses a blood test, which test 100 different foods to diagnosis food allergy. A person can become allergic to almost any type of food and any combination of foods. Therefore, an accurate diagnosis is important.

Depending on how severe a person’s symptoms are there are different ways to treat food allergies such as desensitizing a person, total elimination and improving digestion. Without treatment our immune system will become depleted and symptoms can become worse over time.

Meal Planning Sites and Apps

Transitioning into healthier eating is easier said then done.  It can feel overwhelming, especially when you have others to cook for.  Why not makes things easier on yourself? These food sites are easy to use, and have a lot of great information. 

Plan to Eat

The menu planner is at the heart of Plan to Eat.  Easily drag recipes from your recipe book to create your personalized meal plan, and then add additional ingredients, events and notes.  Save existing mean plans from you planner as menus, then drag them back to your menu planner to simplify future planning

Relish 

For everything having to do with food including in season recipes, holiday recipes and ideas, cooking how-to’s, a collection of clean eating recipes for moms, and a lot more.

eMeals  

eMeals has you choose a meal plan based don your eating style (low carb, lowfat, gluten-free), your family size, and even your favorite grocery store.  Every week, your meal plan arrives in your inbox and includes seven dinner recipes.  Each includes an entrée and side dishes.

Dine without Whine 

Dine Without Whine’s website features weekly menus and categorized grocery shopping list that you.  Once you sign up you will receive a menu and shopping list via e-mail each week by Thursday afternoon.  

Menus 4 Moms 

Menus 4 Moms provides weekly menus and grocery list depending on your time, budget, and dietary restrictions. The website also has quick and easy recipes to print off if you are not ready to enroll in their service.  

Cooking Light

Cooking Light’s website has tons of good recipes, plus nutritional info, and tips for living a healthy lifestyle.

Eatingwell 

This website contains recipes for all occasions, plus information on diet and health, free cookbooks, a menu planner and a lot more.

Allergy Free Cookbooks

Top allergy-free cookbooks to stock in your kitchen cupboard

Living Without Gluten 
Developed by Peggy Wagener to help others with gluten intolerances.  For more information go to 
livingwithout.com

The Allergy Self-Help Cookbook: Over 350 Natural Foods Recipes; Free of all common food allergies.  This book contains updates nutrition information, recipes, tips and more.  For more information, click HERE

The Whole Foods Allergy Cookbook: Two Hundred Gourmet & Homestyle Recipes for the Food Allergic Family.  This cookbook contains recipes aimed at eliminating each of the 8 allergens responsible for 90% of food allergies.  For more info, click HERE

What to Eat When You Can't Eat Anything: The Complete Allergy Cookbook.  Offers more than 120 recipes for all types of food sensitivities. For more information, click HERE.

Allergy-free Cookbook: No eggs, no dairy, no nuts, no gluten
Alice Sherwood, a former BBC TV producer whose husband and son have serious food allergies, used her degree in chemistry and love of food to write her own cookbook. For more information, click HERE. 

Lavan Cooks Dairy-Free! A Healthy, Simple Approach to Your Favorite Foods
This cookbook contains lower calorie recipes that use natural dairy substitutes such as soy, rice, oat, and almond milks.  For more information, click HERE. 

The Ultimate Food Allergy Cookbook and Survival Guide: How to Cook with Ease for Food Allergies and Recover Good Health.
This cookbook contains more than 500 sugar-free recipes that work for gluten-free or dairy-free diets.  The book also contains a ton of information about how allergies are developed and how they can be treated.  For more information, click HERE.  


*In case you missed it, check out our newsletter, containing feature article in the Vail Daily, "Clean Out for Spring," earth-day tips, allergy blogs, an immune boosting recipe!*

Learn to Manage and Eliminate Allergies

Spring is here and so is the full blown allergy season.  According to the American Academy of Allergy and Asthma Research sixty million people in the US suffer from allergies and this includes forty percent of all children.  

The cost to our society of just treating allergic rhinitis is estimated at over $11 billion.  Allergic disorders include hayfever, allergic rhinitis, eczema and dermatitis. Allergic triggers can include airborne, food and water contaminates such as tobacco smoke, pesticides, heavy metals, pet and pest dander, food allergens, infectious agents such as viral, mold and stress.  When we are exposed to an allergic trigger certain parts of the immune system get over stimulated this results in an over production of inflammatory mediators causing excessive mucous production and thus an allergic reaction.

Once the cascade of immune deregulation is triggered allergic symptoms often develop and once you develop one allergic trait such as eczema, others are likely to follow such as food allergies, asthma and allergic rhinitis.  One of the core principles of naturopathic medicine is that prevention is preferable to treatment whenever possible.  Prevention is always safer, more effective and less expensive.  Ways one can help prevent allergies are eating a healthy diet, eating organic whenever possible, and staying away from foods to which one can be allergic.

There is a clear link between seasonal allergies and food allergies. In some individuals’ allergic rhinitis due to pollens, ragweed and grasses are connected to food allergies. In other words, when you eliminate the individuals food allergies the environmental allergies go away.  And if you do not eliminate the allergic foods the environmental allergies will continue to get worse every year. 

Keeping our immune system healthy by taking a good multiple vitamin is also needed.  Scientific studies complied by the Organic center in May of 2010 show that vitamins A, C and D actually protect us from getting allergies. According to Allergy Clin Immunology June 2009 studies are also showing consistently that the majority of our children today are vitamin D deficient and these children are at an increase risk of developing asthma and other allergies.  To further help prevent allergies in our children breast feeding is also recommended for the first year of life.

With this allergy epidemic upon us the challenge is not to develop more aggressive and costly treatments but to implement more effective preventive strategies.  By determining the cause of your allergies such as a lower immune response, nutritional deficiencies and food allergies one can get rid of allergies altogether. 

For an appointment on how to address and manage your allergies call 970-926-7606.
  

Dr. Deborah Wiancek is a naturopathic doctor who has a family practice at the Riverwalk Natural Health Clinic & Pharmacy in Edwards, Colorado.  She has been practicing in the Vail Valley for the last sixteen years. To schedule an appointment please call 970-926-7606 or Wiancek@healthref.com,  www.healthref.com or www.riverwalknaturalhealth.blogspot.com. 

Allergy Season is upon us. What can you expect?

An allergy is an inappropriate response by the body’s immune system to a substance that is not normally harmful. 

What is an allergy?  An allergy is an inappropriate response by the body's immune system to a substance that is not normally harmful.  In some people, the immune system wrongly identifies a nontoxic substance as an invader, and the white blood cells overreact and do more damage to the body than the invader.

What are common signs and symptoms of environmental allergies? Seasonal nasal congestion, itching, burning eyes, hives, coughing and headaches.

The most common substances that can provoke seasonal allergies in Colorado include? Trees such as Elm, Cottonwood, Cedar, Juniper, Pine and Aspen. And other plants such as ragweed, pollen, thistle, dust and sage.

Other substances that can provoke an allergy include: Nickel, cosmetics, lanolin, animal dander, dust mites, some common drugs such as penicillin, aspirin and sulfa drugs, some food additives such as benzoic acid and sulfites and chemicals found in soap and laundry detergents.

Many people are allergic to molds. Molds can live throughout the house, under the sink and in the bathroom, basement, refrigerator or any dark and damp place. Mold spores are carried in the wind and predominate in the summer and early fall. Cutting grass, harvesting crops or walking through tall vegetation can provoke a reaction.

Foods can also provoke allergic reactions. Some of the most common allergenic foods include chocolate, dairy products, eggs, shellfish, strawberries, citrus fruits, corn, wheat, food additives, preservatives and dyes.

What kind of natural treatments are available for environmental allergies? Dr. Wiancek uses homeopathy to desensitize a person from their specific environmental allergies. She also uses natural anti-inflammatory products and Chinese herbs depending upon how severe the reaction. 

What is the difference between a food intolerances and food allergy? A person with a food intolerance is unable to digest and process food correctly, usually due to a lack of a certain enzyme or enzymes. A food allergy occurs when a person’s immune system generates an antibody response to the injected food. Food intolerances can lead to an allergy, if particles of undigested food manage to enter the bloodstream and cause a reaction.

What are the most common symptoms of food allergies?  There are many symptoms related to food allergies these include:

Recurrent colds, sore throats, chronic tonsillitis, ear infections, ringing and buzzing in the ears, chronic nasal congestion, postnasal drip, Meniere’s syndrome, constipation, diarrhea, abdominal cramping, ulcerative colitis, gallbladder disease, irritable bowel disease, migraines and other headaches, hives, canker sores, psoriasis, eczema, acne, asthma, frequent urination, teeth grinding, bedwetting, colic, muscle aches, osteoarthritis, rheumatoid arthritis, unexplained fatigue, anxiety, depression, insomnia, food cravings, obesity etc. Most of these disorders have more than one cause, but food allergy is a relatively common and frequently overlooked cause.

How is a food allergy best diagnosed? Dr. Wiancek uses a blood test, which test 100 different foods to diagnosis food allergy. A person can become allergic to almost any type of food and any combination of foods. Therefore, an accurate diagnosis is important.

Depending on how severe a person’s symptoms are there are different ways to treat food allergies such as desensitizing a person, total elimination and improving digestion. Without treatment our immune system will become depleted and symptoms can become worse over time.

Tips for Families to Prevent Allergies

Our environment is loaded with potential allergy triggers.  While avoiding the outdoors entirely in springtime is not feasible, one should aim to limit exposure to pollen and other common airborne triggers (e.g. tobacco smoke).  Wash off pollen from hands and other exposed areas in peak allergy seasons.

- Keep windows and doors closed during high pollen count times and stay inside on the driest, windiest days to minimize exposure to seasonal allergens. 

- Use high-particulate air (HEPA) filters inside to reduce most airborne contaminants, especially in bedroom locations. 

- In humid areas, use a dehumidifier to limit mold development. 

- Buy allergy-proof bedding, including mattress and pillow case covers, to reduce allergy symptoms, and regularly wash sheets, blankets and pillow cases in hot water.

- Stuffed animals and real animals alike can contribute to allergic rhinitis, so wash them frequently.

- Consider removing carpeting in bedrooms or use area rugs which can be cleaned regularly. 

- Vacuum all carpets and floor surfaces weekly with a HEPA-filter equipped appliance.

- Limit lawn mowing and other gardening activities at peak allergy times; avoid use of chemical pesticides and outdoor products.

- Use environmentally- and health-safe household cleaners.

- Eat healthy, whole organic foods with plenty of anti-inflammatory antioxidants.

- Avoid use of herbal products and foods that can cross react with seasonal allergens; for some people this may include Echinacea species and certain fruits and vegetables (this is known as the “oral allergy syndrome”).

- To prevent allergic disease in babies, consider perinatal avoidance of known food allergens especially if there’s a family history of atopic disease; breastfeeding is known to be protective as         well.

- Try a saline rinse device called a “neti pot” to clear pollen from the nasal cavities.  Even children as young as 2 or 3 years old can be taught how to use one.

- Look into using specific natural health product supplements, like probiotics and essential fatty acids, which may lower your risk of developing allergies.

- Think about taking up a stress-coping technique, like yoga or meditation.

Why Can't I Lose Weight? Preping for Your New Year's Resolution

The New Year is upon us and one of the top resolutions is to lose weight.

The New Year is upon us. Many people have made their resolutions, but have not started them yet.  One of the top resolutions people make is to lose weight.  Most people gain from five to seven pounds between Thanksgiving and New Year’s.  If they do not lose that weight right away it starts accumulating year after year, and over time the weight becomes harder to lose. Most diets do not focus on obtaining a healthy state of being which is essential for maintaining an optimal weight. Thus, any one diet will not work for everyone. Once individuals get off their diet, the weight comes back on because they go back to their old eating habits.

As we get older it becomes harder and harder to lose weight. There are many reasons why a person cannot lose weight.  For example, the thyroid may not function optimally. Since the thyroid regulates metabolism, if the thyroid is not functioning, one will not lose weight regardless of the diet.  The adrenals work with the thyroid to control ones energy and inflammation in the body.  If a person does not have the energy to exercise, their adrenals may not be functioning properly.

Menopausal women also tend to have a problem with weight gain. This is due to hormone fluctuations such as estradiol, progesterone, thyroid, adrenal, DHEA and testosterone. Thus, if a woman is going through menopause she may want to get her hormones checked. 

Insulin resistance and adult onset diabetes also plays a role with weight gain; individuals with insulin resistance generally have high blood pressure, high cholesterol and are over weight.  Many individuals also have food allergies that affect weight gain.  By identifying food allergies and eliminating these foods, individuals can lose 8 to 10 pounds in two weeks. Other individuals may have celiac disease. When these individuals get off gluten they lose weight more easily.  As you can see, there are many different reasons why a person cannot lose weight. This is why no one diet will fit everyone.

Allergy Season is upon us. Are you experiencing allergies?

What is an allergy? 

An allergy is an inappropriate response by the body’s immune system to a substance that is not normally harmful. In some people, the immune system wrongly identifies a nontoxic substance as an invader, and the white blood cells overreact and do more damage to the body than the invader.

What are common signs and symptoms of environmental allergies? 

Seasonal nasal congestion, itching, burning eyes, hives, coughing and headaches.

What are the most common substances that can provoke seasonal allergies? 

In Colorado these include trees such as Elm, Cottonwood, Cedar, Juniper, Pine and Aspen, and  other plants such as ragweed, pollen, thistle, dust and sage.

Other substances that can provoke an allergy include:

nickel, cosmetics, lanolin, animal dander, dust mites, some common drugs such as penicillin, aspirin and sulfa drugs, some food additives such as benzoic acid and sulfites and chemicals found in soap and laundry detergents.

Many people are allergic to molds. Molds can live throughout the house, under the sink and in the bathroom, basement, refrigerator or any dark and damp place. Mold spores are carried in the wind and predominate in the summer and early fall. Cutting grass, harvesting crops or walking through tall vegetation can provoke a reaction.

How does natural treatments differ from traditional allergy treatments? 

Natural treatments do not use drugs such as steroids that treat only the symptoms and tend to mask the cause.   Natural treatments build the immune to prevent allergies.

What kind of natural treatments are available for environmental allergies? Dr. Wiancek uses homeopathy to desensitize a person from their specific environmental allergies. She also uses natural anti-inflammatory products and Chinese herbs depending upon how severe the reaction. 

 Most people with environmental allergies have food allergies.  When you identify the food allergies and eliminate them the environmental allergies go away. 

What foods can provoke an allergic reaction? Some of the most common allergenic foods include chocolate, dairy products, eggs, shellfish, strawberries, citrus fruits, corn, wheat, food additives, preservatives and dyes.

What are the most common symptoms of food allergies?  

There are many symptoms related to food allergies these include:

Recurrent colds, sore throats, chronic tonsillitis, ear infections, ringing and buzzing in the ears, chronic nasal congestion, postnasal drip, Meniere’s syndrome, constipation, diarrhea, abdominal cramping, ulcerative colitis, gallbladder disease, irritable bowel disease, migraines and other headaches, hives, canker sores, psoriasis, eczema, acne, asthma, frequent urination, teeth grinding, bedwetting, colic, muscle aches, osteoarthritis, rheumatoid arthritis, unexplained fatigue, anxiety, depression, insomnia, food cravings, obesity etc. Most of these disorders have more than one cause, but food allergy is a relatively common and frequently overlooked cause.

How is a food allergy best diagnosed? 

Dr. Wiancek uses a blood test, which test 100 different foods to diagnosis food allergy. A person can become allergic to almost any type of food and any combination of foods. Therefore, an accurate diagnosis is important.

Depending on how severe a person’s symptoms are there are different ways to treat food allergies such as desensitizing a person, total elimination and improving digestion. Without treatment our immune system will become depleted and symptoms can become worse over time.

If you suspect you may have an environmental or food related allergy it is best to get an assessment.  Without treatment your immune system can become depleted and symptoms can get worse. For any question please call Dr. Wiancek at 970-926-7606 or e-mail Wiancek@healthref.com website  www.healthref.com.