We love this delicious and EASY recipe! Yummy… spicy shrimp with garlic, zucchini noodles, tomatoes and a squeeze of lemon juice… just try to not inhale it! Low-carb, gluten-free, high protein and rich in nutrients – a perfect combo for your fit bariatric lifestyle!
1 1/2 teaspoons olive oil
Pinch crushed red pepper flakes
4 oz peeled and deveined shrimp
2 cloves garlic, sliced thin and devided
1 medium zucchini, spiralized
Pinch salt and fresh black pepper
1/4 cup halved grape tomatoes
*Heat a medium nonstick skillet over medium-high heat. Add 1 teaspoon of the oil and crush red pepper flakes, add the shrimp and season with pinch salt and pepper; cook 2 to 3 minutes.
*Add half of the garlic and continue cooking 1 more minute, or until the shrimp is cooked through and opaque. Set aside on a dish.
*Add the remaining 1/2 teaspoon oil and garlic to the pan, cook 30 seconds then add the zucchini noodles and cook 1 1/2 minutes. Add the shrimp and tomatoes to the pan and squeeze the lemon over the dish.
*Remove from heat and serve. Makes 1 serving.
Servings: 1, Size: 1 zucchini + shrimp
Protein: 25 grams
Carb: 14.5 grams
Fat: 9 grams
Paderno Spiral Vegetable Slicer is an all time FAVORITE cooking gadget. It’s the easiest way to make zucchini noodles, sweet potato spirals, carrot ribbons and more! Prior to owning one, I used my mandolin but it’s so much quicker and easier (and safer) with this fun gadget – you NEED one!!
This recipe was originally published on Skinnytaste.com
Nishi and partners teach students at Sunrise Elementary about their bodies. PHOTO COURTESY KHALILI CENTER
At Sunrise Elementary School in Boyle Heights, teachers were noticing their students having fried food and a Coke for breakfast, and Flamin’ Hot Cheetos and another Coke for lunch. They knew a change had to be made. This inspired bariatric surgeon Gregg Kai Nishi, M.D., and his partners at the Khalili Center for Bariatric Care in Beverly Hills to volunteer at LAUSD schools to teach kids about obesity awareness and prevention, and how to make healthy lifestyle choices.
“We as a society don’t do much to educate our public about the dangers of overeating or eating fast food and not exercising,” says Nishi. “At first, the kids weren’t familiar with a lot of different types vegetables, and what was healthy for you versus what wasn’t… We explained why [doctors] do the things they do, and what parts of the body can be affected by not eating healthy.”
When Nishi visited Sunrise Elementary School, he would show up in his scrubs and white coat. He role-played with the students, letting them be the doctor so they would be less afraid. He then developed a program to teach the kids to be healthier. The doctors would talk to the students about eating healthy and making healthy choices, and then go outside and exercise with them.
Nishi took some of the practices he uses for adult patients and introduced them to the kids as well. He gave the students at Sunrise Elementary pedometers and helped them set goals for how far they should walk each day. The Khalili Center also sponsors their patients to participate in the LA Marathon 5K, and, with the help of Nishi and the center, many kids are now participating in the event.
Nishi exercising with the kids at Sunrise Elementary. PHOTO COURTESY KHALILI CENTER
The students at Sunrise Elementary were so inspired by what Nishi was teaching them that they began to share their newfound knowledge. Kids would go home and share with their families what they learned about being healthy. Their passion grew strong enough that they were even able to get the taco truck in front of the school to serve fresh fruits and vegetables.
Nishi’s top three healthy lifestyle tips include making healthy food choices, exercising and surrounding yourself with people who do the same thing. All of the technology of today tempts kids to just be at home, but Nishi encourages parents to stress the importance of getting outside. “Don’t just say it, do it together. It is not easy,” Nishi says, “but in order to save ourselves, society and our children, we have to put in a little bit of effort to make a change.”
This article originally appeared on LAParent.com
Make it a daily routine for better health and weight as a Bariatric Patient!
* Egg Muffins
Egg whites, steamed broccoli, light cheese and seasoning. Freeze for the month ahead!
*Yogurt Parfait Swirl
6-8oz 0% Greek yogurt topped with 2-3 TBS whole grain cold cereal and 2-3TBS berries Sweeten with Truvia/Stevia as preferred
*Double the Protein
4oz 0% Greek yogurt mixed with 4oz low fat cottage cheese and 1TBS low sugar jam
*Cheesy Veggie Sausage
1-2 soy veggie sausage patties with melted low fat cheese slice and tomato
*Egg Scramble it Up
2 Egg whites scrambled with 1 whole egg, splash milk and parmesan, sliced tomato with cracked pepper; or egg whites scrambled with extra lean turkey or soy sausage crumbles; or egg whites scrambled with ½ extra lean chicken sausage, sliced tomatoes
Egg whites whipped with seasoning and quick sautéed vegetables added to make a large egg pancake in nonstick pan. Flip over, sprinkle parmesan and yum!
2 soft cooked eggs over sautéed spinach sitting atop a baked corn tortilla
*Guilt-free Eggs Florentine
Over-easy eggs resting on sautéed spinach and sliced tomato, light drizzle of the fabulous Florentine sauce
Photo courtesy of skinnytaste.com
Did someone say naked? We love this recipe! Some burgers are just meant to be eaten without a bun. These salmon burgers are the perfect example. Eat up…these are some of the best protein you can eat for your fit bariatric lifestyle!
For the Spicy Sriracha Mayo:
3 tbsp light mayonnaise (Hellman’s)
1 tbsp sriracha
For the salmon patties:
1/4 cup red bell pepper, diced
1/4 cup yellow bell pepper, diced
6 tbsp panko
1 clove garlic, minced
1 pound wild salmon fillet
1 large egg, lightly beaten
1/2 tablespoon reduced sodium soy sauce
1 teaspoon fresh lemon juice
1/4 teaspoon kosher salt
4 cups baby arugula
4 oz avocado, sliced
*Combine mayonnaise and sriracha, set aside.
*Remove the skin from the salmon, and cut about a 4 oz piece off. Place in a food processor or chopper to finely chop. This will help hold the burgers together. With a knife finely chop the remaining salmon.
*In a medium bowl combine the salmon with the bell peppers, panko and garlic.
In a small bowl, combine egg white, soy sauce, lemon juice, and salt; add to salmon mixture, tossing gently to combine.
*Form mixture into 4 patties and refrigerate at least one hour, this will help the burgers become firm and hold together during cooking.
*Lightly coat a grill pan or skillet with cooking spray. Place over medium-high heat until hot. Cook the patties 4 to 5 minutes per side, or until cooked through.
*Place arugula on each plate, top each with salmon burger, 1 tbsp of mayo and avocado slices – enjoy!
Servings: 4, Size: 1 burger
Protein: 26 grams
Carbohydrate: 11 grams
Fat: 15 grams
Recipe adapted from Paula Deen for Food Network
This recipe is originally from Skinnytaste.com
Weight loss surgery is a big money business, but they can ultimately save the healthcare system cash and save patients years of poor health — if they are ready to commit to changing their lives.
If a bariatric procedure needs to be redone, doctors call it a revision. While that seldom happens anymore in operating rooms, the industry itself has undergone a sort of revision in the past several years.
Bariatric surgery has been around in some form since the 1960s. But in those early years, surgeons did whatever they thought would be safe and effective. There were no hard and fast surgical guidelines like there are today, with an accrediting organization like the American Society for Metabolic and Bariatric Surgery (ASMBS).
Now, the safety and efficacy of weight-loss surgery is widely accepted by groups such as the American Heart Association and the American Diabetes Association. The surgery can lead to dramatic weight loss. Some people lose 100 pounds in six to nine months.
The American Medical Association last year opted to classify obesity as a disease. Obesity affects more than 78 million Americans, according to the U.S. Centers for Disease Control and Prevention (CDC). It can lead to any of 40 other diseases, including diabetes, heart disease, arthritis, stroke, and even cancer. Obesity cost the U.S. economy $198 billion in 2011, according to a report published by the Society of Actuaries.
Research shows that weight-loss surgery can cure type 2 diabetes, dramatically lower the risk of heart disease, and, in theory, save health insurers loads of money. Whether the savings are actually accruing is still up for debate.
While bariatric surgery is a huge moneymaker and is typically covered by insurance, it won’t be successful if the patient isn’t ready for their new body. The industry has begun to recognize that the procedure is not one-size-fits-all. It has backed off from aggressive billboard marketing campaigns and is being choosier about which patients are approved for the surgery.
It is major surgery and has about the same mortality rate as gallbladder surgery, Dr. John Morton told Healthline. Morton is chief of bariatric and minimally invasive surgery at the Stanford University’s School of Medicine and serves as president-elect of ASMBS.
Not Something to Be Taken Lightly
Obesity is a health problem, and bariatric surgery is at least a short-term cure. But in the heyday of bariatric surgeries about a decade ago, aggressive marketing caused many people to ask about it without thinking things through, Dr. Eraj Basseri told Healthline.
Basseri is a surgeon at the Khalili Center in Los Angeles. The center performs all three types of bariatric surgery — Lap-Band, sleeve gastrectomy, and gastric bypass.
Lap-Band has traditionally been heavily marketed as a safe, affordable weight loss solution. But it has the highest failure rate of all bariatric surgeries. Gastric bypass, where food is rerouted past a large part of the stomach, tends to be more successful. With Lap-Band in particular, people can “cheat” after the surgery, Basseri said. They can suck down liquids loaded with carbohydrates, such as milkshakes, and they won’t feel full.
The arrival of Lap-Band, which works for many people, seemed to herald a quick-fix for weight loss. Basseri spoke of communities with dueling billboards all over town that screamed “Get your bariatric surgery here!” Surgical centers ended up attracting patients who were uneducated about the surgery and who were not provided with pre- and post-operative care.
“What the billboards did, especially in Los Angeles, was make a serious operation into a one-hour lunch meeting,” Basseri said.
He said the surgery itself comprises only one part of the goal of losing weight and keeping it off. “If you don’t focus on their psychological aspects, the nurturing and the support, the [patients] won’t succeed,” Basseri said.
To put it bluntly: “They have a messed up relationship with food,” Basseri said. “The relationship with food has to improve. This first year (after the surgery) is the honeymoon phase, as we like to call it, and the relationship with food during that time has to get better.”
Candidates Must Be Mentally Ready
Aggressive ad campaigns were pervasive not only in body- and health-conscious Los Angeles. Even in the mid-sized Quad-Cities, an assortment of bi-state communities straddling the Mississippi River in Iowa and Illinois, hospitals heavily marketed bariatric surgery.
Sara Neyens is nurse manager for the surgical weight loss program at UnityPoint Health-Trinity in Moline, Illinois. She said the program has come a long way since about 10 years ago, when business was booming. She said back then getting the surgery was simple, but there wasn’t much support or education.
“It was obvious to the insurance as well as the medical communities that this was not the way to go,” Neyens told Healthline. “Patients are not successful if they do not have their dietary and mental health needs met, pre- and post-op.”
Now, potential patients are put through extensive counseling and education. Not only do they get a complete physical check up, including cardiovascular and sleep tests, but they receive extensive mental health counseling as well. “It’s stressful on the body, but it’s also stressful mentally,” Neyens said.
Trinity requires patients to have a new exercise and diet regimen in place before the surgery will be performed. Anyone weighing more than 400 pounds has to lose weight first with diet and exercise before the hospital will operate.
But psychological support is also necessary as people who have the surgery begin to live a new life. “From time to time, people will make comments even though they don’t mean to be hurtful,” Neyens said. “They’ll say things like, ‘You’re not eating very much. That can’t possibly be healthy. Are you not feeling well?’ And some people get jealous.”
Are We Saving Money by Living Healthier?
How far do the benefits of the surgery go? It is now well established that the procedure can reverse type 2 diabetes, sometimes even if a patient is still obese. People living with a host of health problems, from cardiovascular disease to arthritis pain, slowly see their need for medications evaporate.
The surgery costs about $30,000, Basseri said. The idea is that if the surgery jumpstarts weight loss and people begin to feel better by looking great, they permanently adopt a healthy lifestyle of exercise and sensible eating.
“When it gets rid of that diabetes it’s not just a couple of hundred [saved] a month for that insulin, but for that amputation that would have happened five years down the line, or pneumonia, or stroke,” Basseri said.
A study on the value of bariatric surgery came out in 2010. Published in the journal Diabetes Care, the article concluded that gastric bypass and gastric banding were cost-effective ways to improve outcomes for severely obese people with diabetes. It affirmed that the surgery can reverse type 2 diabetes independent of weight loss.
It did not find the surgery to be less expensive than medical management, but it also did not factor in cost savings related to other health problems that may have been resolved by the weight loss. “For example, decreasing blood pressure or decreasing the need for joint replacement could definitely reduce costs for surgical patients,” according to a summary published in the Canadian Journal of Surgery.
But the issue of joint replacements is a tricky one when assessing bariatric surgery’s financial impact on the healthcare system. In a study published last year in the Journal of the American Medical Association, Surgery, researchers showed that medical costs remained the same even six years after the surgery.
Morton pointed out one possible reason why. While some people may not need joint replacement once they lose weight, for others it still may be a necessary procedure. Major operations such as joint replacements can’t be performed on unhealthy, obese people. Bariatric surgery sometimes allows other surgeries that had been put off to finally be performed.
A New Lease on Life at 65
Kathy Maugh had gastric bypass surgery at the age of 65. She never had a weight problem until later in life. It wasn’t so much her weight that bothered her as it was the threat posed by the type 2 diabetes she had developed.
She chose the Khalili Center because they had saved her husband’s life. He had bariatric surgery back in the 1960s, when there were no set guidelines. Khalili did a revision for Maugh’s husband, Thomas.
But Maugh, a scientist by training, backed out of the surgery three times before finally deciding to do it. The intensive pre- and post-operative commitments seemed to be too much.
“I definitely regret not having the surgery sooner,” she told Healthline. “The surgery gave me back my life and then some and I wasted all those years. I backed out because I was afraid of anything that radical, but it was an unfounded fear.”
Some opponents of bariatric surgery have said it should only be used as a last resort. In fact, that’s the opposite of what we should be doing to realize optimal savings to the healthcare system, Morton said.
Maugh agrees. “I have definitely saved money and the ‘system’ has benefited as well. Medicare and my supplemental insurance pays most of my medical and handles the deductible and the co-pays on the prescriptions,” she said. “Since the surgery, I am on no medications and therefore no co-pays. I recently began a prescription medication for neuropathy but that has nothing to do with the surgery with the exception if I had controlled my diabetes earlier in the progression of the disease I might not have neuropathy now.”
Morton said about 80 percent of bariatric surgery providers are accredited by ASMBS. ASMBS-accredited surgeons commit to at least five years of follow up with a patient after surgery.
Basseri said obesity has put a strain on the healthcare system that bariatric surgery is attempting to ease. “We’re too sick as a country,” he said. “Individuals in this country need too much treatment.”
This article was originally published by Healthline.com
When lactose is a concern, how can a bariatric patient choose from all the non-dairy “milks?”
Tips to choose the right milk:
1. Soy milk has the most protein and a good nutrient profile if you do not mind soy products. Choose a low sugar variety.
2. Rice milk is perfect for those with food allergies because although it is low in protein and at times higher in sugar it is the least allergenic.
3. Almond milk is a delicious alternative to soy milk with a nice flavor and an adequate nutrient profile. However, please note that the protein content is low at around 1-2 grams only!
4. Hemp milk can be desirable if you watch the sugar grams and it has slightly more protein then almond milk.
5. Oat milk and some of the other grain “milks” can provide an adequate nutrient profile however watch the sugar and it is not as popular for flavor as the soy and almond “milks.”
6. Coconut milk is not a good choice for a healthy lifestyle. It is low in protein and high in fat.
You’ve heard the news by now: Sitting is the new smoking. It’s been linked to an increased risk of diabetes, cardiovascular disease, and early death. Not to mention possible potato-like proportions. But with most of us logging hours at desk jobs (and recovering from hard workouts with Netflix binges), can it really be that bad?
Yes, indeed, says Vladimir Friedman, DC, CCSP, of Accelicare Sports Chiropractic in Manhattan. “When you’re in an improper slouched or seated posture for extended periods of time, there is physiological change in the body,” he says. “In addition to the proven disease risks, things start to lock up. Tissues can weaken and the effects can be degenerative.” (In fact, Friedman often shows clients how to apply kinesio tape in a crisscross pattern at the low back to teach them how to stay in proper alignment when sitting.)
Friedman likens the idea to time spent in a cast: When muscle tissue is continually immobile, it shortens and shrinks over time and weakens. But give your body a load using your own body weight—from standing to squatting to taking a walk—and the measure of stress provided helps strengthen it.
“Movement brings hydration and nutrients to the tissue and activity keeps it healthy, so even though our jobs and evolving ‘mobile’ technologies are making us more prone to sit and press buttons, we need to think actively and sit actively,” he says.
In other words, don’t just get up for breaks, but rather do things that will keep your tissues mobile and fluid throughout your day—and life. Here, Friedman’s sit-active guideline:
1. Roll your feet
Feet can really stiffen up when you sit for long periods and a lack of mobility in the ankles and calves can become a problem. Take a couple breaks during your day and roll each foot on massage ball or small frozen water bottle. Shoe off, press down on the ball or bottle and roll it back and forth over the arch of your foot allowing the pressure to loosen up the tissues and increase circulation.
2. Do some wall squats
Sit with your shoulder blades and lower back against a wall, hips and knees at a 90-degree angle. Hold for a minute and do 3 reps. No need to to overdo it with reps; these squats are not about fitness gains, but prevention of degeneration.
3. Stretch into a lunge
Constant sitting shortens the hip flexors, so you need to stretch the anterior capsule and surrounding musculature of the hips as well as the quads. Step your left leg forward into a 90-degree lunge, allowing the right knee to hover over the ground behind you. Then switch legs. Try to work this in 3-4 times a day.
4. Reverse your rotation
During prolonged sitting, we tend to collapse inward, rounding our shoulders and jutting our necks out and forward. To reverse this, move to the edge of your chair and sit on your tailbone. Leaving your arms at your sides, open your chest and rotate your hands out, letting your shoulders move back. At the same time, widen your hips by rotating your feet out. Hold for 10 seconds and repeat 10 times.
5. Extend your back
This exercise was created for disc herniation injuries but it’s perfect for reversing a sitting posture. Stand and place the palms of your hands on the sacroiliac joints at your lower back to lock out your lumbar spine and prevent overextension. Then gently lean back as far as you comfortably can. Do 10 reps, once or twice a day.
This article originally appeared here
You Can Find More Information at Khalili Center for Bariatric Care
For many individuals growing up overweight, the need to psychologically protect themselves from criticism and manage their internal shame became a habitual act of self-protection. At the expense of the development of a true self, the psychological protection included destructive behaviors as forms of punishment. In addition, a false self (rather than a true self) may have developed focused on pleasing the needs of others as a way of distancing oneself from painful feelings.
As a sense of inner strength developed with the shedding of pounds there could also have developed an overwhelming sense of anxiety over a loss of “Self”. Although that sense of self was someone laden with negative feelings it was still someone that was recognizable. Not knowing who one is and not having developed into who one will become can create anxiety and emptiness akin to feelings of death. An old sense of self must die for a new one (true self) to be reborn. That process can be terrifying and may be filled with the reactivation of psychic trauma. The process of being reborn is painful. Self-destructive behavior can be a form of returning to the womb – the illusion of safety and security. Having a true self is very important.
Reduce Self-Destructive Behavior and Your True Self
In order to reduce any self-destructive behaviors you have and cope with that pain, it is important to develop your true self. To develop a strong sense of self there are seven essential factors to consider:
The Seven Essentials to the Emergence of Self:
1. You experience a unique need for growth.
2. There is an atmosphere of security — there is support and good will.
3. You develop an inner freedom — an ability to express your feelings.
4. You can experience healthy conflicts — you can mature within the context of relationships.
5. You understand the development of conflicting desires in your own life and understand/accept differences in others.
6. You recognize and accept the need for solitude as well as the need for social interactions.
7. You develop the ability to fight for your beliefs. You develop creative solutions to conflicts with the environment, with yourself, and with others — you have a healthy understanding of compromise.
To retain a true sense of self that is not burdened with self-destructive behavior one must display of fortitude and a passionate desire to tell the truth and not resort to overeating. This is key to the emergence of a “True Self”. It is at the heart and soul of the act of taking responsibility.
This information was previously published by Obesityhelp.com
Learn more about the Khalili Center for Bariatric Care Here
Now that Labor Day has passed, take these bariatric friendly recovery tips to heart to stay on track!
- Make it your goal today to consume 10 cups of water between meals today and “flush it out” while you give yourself more energy at the same time!
- Make each of your meals protein rich and chew them slowly to maximize your satiety and keep you away from those processed and overly salted chips you might be thinking about having again today!
- Take a walk with a friend or get to the gym as soon as you can to sweat it out and feel cleansed!
- Eat 2 servings of fruit for its thirst quenching and healthy nutrition!
- Keep yourself out of trouble by brushing your teeth early and calling it a night by 10pm. You’ll save yourself from post dinner cravings!
We all know the research… working out is important for your health and so is getting enough sleep. For most of us, fitting in both leaves us trying to determine which one we need more of because doing both just seems impossible some days.
You tried waking up early because it’s the best way to ensure you get your workout in (before the day gets away from you or you can think of an excuse). Then, you started trying to get to bed earlier so you’d still be getting enough sleep for your new wake up time. But then you started running out of time at night to do… well, anything! By the time you pick up the kiddos, make dinner, and get everyone situated, you literally have 15 minutes to yourself before you know your head should hit the pillow to get the minimum amount of sleep to be considered a functioning human being. So, which one needs to go… the workout or the sleep?
Working Out vs. Sleeping
The answer, unfortunately, isn’t that simple. Working out and sleep are both crucial to your health.
Working out and being active helps you*:
Builds self esteem
Enhance body image
Makes you happy
Keeps your brain fit
Oh yes, and that doesn’t even scratch the surface about what’s happening to you physiologically (weight loss, stronger heart, muscles, reduction of low back pain, and more). [according to US News & World Report, March 7, 2012]
Improve physical performance
Helps with focus and attention
Helps weight loss or maintenance
Helps avoid accidents
Helps avoid depression
Ratio of Sleep Needed
According to research, sleep has a direct impact on working out. Stages 3 and 4 of sleep are the ones most important to exercise recovery. Human Growth Hormone (HGH) is just starting to be released during Stage 3 and this continues into Stage 4 (deep sleep). Stage 4 is the time when your physical and mental energy are restored. Not getting into Stage 3 and 4 or not often enough, and your workouts could be compromised due to lack of recovery. There’s also been research to show people workout at a lower intensity and for shorter periods of time when they get a poor night’s sleep.
You’re probably wondering now, just how little sleep can I get and still be OK? This is another challenging question because everyone is different. Generally speaking, most adults need between 7 and 9 hours of uninterrupted sleep per night (National Sleep Foundation 2013). Bottom line, if you are cutting sleep short just a few nights a week to get up early and work out, you may be able to swing it because you can (theoretically) make up for it other nights. But, if you try to keep this up every day, your lack of sleep will catch up with you and affect more than just your athletic performance.
When NOT to Work Out:
Let’s not forget, a lack of sleep has an impact on your physical performance and many caution you should not workout when you’re tired. You run the risk of poor performance, increased risk of injury, a negative impact on your immune system, and interference with tissue repair. Plus, the way exercise feels when you’re tired is never the same as when you are fully rested which might lead to negative feelings about exercise in general.
Of course, working out has been touted as beneficial to increasing sleep quality. A recent study found a positive effect (sleep improved after 16 weeks of exercise, but not immediately) for sedentary women in their 60s with insomnia. Other studies showed insomniacs responding favorably to moderate exercise; it decreased their level of anxiety and they were able to get better sleep at night. Keep in mind, however, experts are still undecided about exercising at night and how it may affect your sleep. Morning and afternoon seem to be in the clear, but avoid working out a few hours before hitting the hay!
So, Which Is It Then?
A ton of data exists to support both sides of this debate… so, what’s the answer? Should I sleep more and workout less, or workout more and sleep less?
Exercise and sleep are equally important for your health. One shouldn’t be sacrificed for the other. If you simply can’t get enough sleep to hit the gym in the morning, you’ll need to find ways to sneak activity in during the day and hold out for longer workouts when you can make it happen after work or on the weekends. Perhaps you could find 15 minutes in the morning, 15 minutes at lunch and 15 minutes after work on the time crunched days? No one said you had to get it all done in one session!
And, if that’s impossible, try to only sacrifice your sleep 2-3 days during the week in order to hit the early morning cycling class, get some extra z’s the other days and, on the weekends, and workout when you can. Voila… best of both worlds!
Which is more important to you?
This article was originally published by AnytimeFitness
The information presented in the blog pages of Khalili Center is for educational and informational purposes only and should not considered personal medical advice. Consult with your personal physician/care giver regarding your own personal medical care.