Dr Jac Daccardi's Blog

Frequently, I see women in my office whose initial appointment starts something like this:  “Well, I felt fine and then, after my last pregnancy, everything changed….” The bottom line is that pregnancy does tend to have a lot of impacts on the body – biochemically, structurally, and neurologically.  And sometimes the body makes adaptations and changes during the process that don’t properly readjust and rebalance after the baby arrives.  I see evidence of that every day in my practice.  In addition to biochemical and endocrine system “shifts,”  something that’s extremely common post-partum is chronic back pain.  Just yesterday I saw yet another case of this in my office.  Let me explain why this happens and what you can do about it: 

Pregnancy itself causes structural changes to the whole body, however, onearea that is greatly affected is the pelvis.  Here’s why:  When muscles are continually stretching to their capacity, muscle spindle cells, which are the neurological feedback loops within each muscle, stimulate the muscles to contract.  So, for example, as abdominal muscles are being stretched to accommodate the growing baby, the response is that abdominal muscles will be stimulated to contract against this stretch.  I suppose this is one reason why pregnant bellies generally feel tight, like a basketball, as opposed to “wobbly.”  The neurological relationship between anterior and posterior paired muscles — everywhere in the body — is that when anterior muscles are in contraction, the posterior related muscles turn off, so to speak.  So, for example, when you flex your bicep, your brain sends a signal that effectively turns off the tricep to allow for the bicep to contract.  So, back to the pregnant belly…. When pregnancy causes the anterior abdominals to stretch to capacity for essentially 9 months, this causes them to flex continually.  The result of flexing continually is that the lower back muscles (which relate to the anterior abs) effectively turn off.  The result of this is that the pelvis loses its stability and structural integrity somewhat, during pregnancy.  This is appropriate, in that it allows for a growing baby to pass through the birth canal, but the side effect is pelvic instability, loss of core muscle stability in the lower back, and back pain!

What can you do about it?  Well, to end lower back pain after pregnancy, it’s important to restore core muscle stability and structural integrity to the pelvis.  The first step is to restore function of the posterior lower back muscles, which are most likely, still getting the signal from the brain that they need to be shut down to accommodate the abdominal flexors.  So, a chiropractor trained in functional neurology techniques has a few low-force techniques to clear out the subtle effects of that neurological pattern and reset the lower back muscles.

Once the neurological patterns associated with pregnancy are removed, the muscles will function in their proper relationships again.  Then, it’s a matter of rehabilitating core spinal muscles that have atrophied a bit.

During this rehabilitation process, it can also be helpful to receive acupuncture techniques or high power laser therapy, both of which can
increase energy and bloodflow to the pelvis and lower back.  High power laser therapy is a cutting edge therapy for which there is research
documenting cellular regrowth, decreased inflammation, and other beneficial effects.

In addition, it can be beneficial in cases of low back pain to determine whether the patient is able to properly absorb vitamin E.  Chronic low
back pain is frequently linked to an inability to properly metabolize vitamin E.  So, a urine or blood test, in addition to the use of applied
kinesiology, may determine whether this is an issue for a patient.

So, that’s a basic discussion of why even a normal pregnancy will often cause low back pain.

Now, with a traumatic birth experience or C-section, there could be low back problems for other reasons as well — nerve damage, disc herniations, heavy scar tissue, can all contribute to pain throughout the body.  I’ll discuss that in a future blog.  Until then, be well!

“Low testosterone, you say?  Well, let’s just throw more testosterone at it. Why not?” 

 Although it’s becoming an increasingly common line of reasoning in the practice of “anti-aging” medicine, it’s not always wise to supplement with any hormone – naturally or pharmaceutically-derived – without fully understanding the reasons WHY the hormone might be low in the first place.  For example, if our car is not performing the way it should, we don’t ALWAYS put a new set of tires on it, do we? Car won’t start?  Put a new set of tires on it!  Ran out of gas?  How about some new tires?  Dead battery?  Must be time for a new set of tires.  You get my point.  Doesn’t make a lot of sense, does it?  And yet, it’s very common for men to be prescribed testosterone for an extremely wide variety of symptoms, which may or may not be caused by low testosterone levels.  The endocrine system is a delicate, self-balancing system, so, when you start changing hormone levels without first understanding underlying causes of symptoms, it can have many unintended and negative impacts on the body’s essential functions.  Once you determine the underlying cause of reduced testosterone levels, a holistic approach to balancing the endocrine system would be one in which underperforming metabolic processes are supported with a variety of drug-free therapies, one of which is targeted clinical nutrition. 

 Back to the topic of testosterone:  Speaking specifically about testosterone supplementation, it is not wise to supplement testosterone unless a person truly has what’s called a “primary hypogonadism” – that is to say that the leydig cells of the testes are not creating enough testosterone. That can happen. There are indeed cases in which the testes do not create enough hormone for one reason or another and, in that case, testosterone supplementation may be a solution.  More often than not, however, this is NOT the case.  There are a lot of reasons why testosterone can be low, just as there can be a lot of reasons why the car isn’t performing well.

 Let’s talk about a common, but complex problem. Older men have less testosterone.  Why would that be? Well, here’s an interesting feedback loop in the body, which helps to tell  the story: 

 Coffee and Doughnuts.

 Coffee, and other beverages containing caffeine, such as the so-called “energy drinks,” have a stimulatory effect on the adrenal glands. The adrenal glands, among other things, secrete a hormone called “cortisol” in response to a variety of processes in the body.  In addition to being stimulated as a response to consuming caffeine, cortisol is also secreted during stressful situations — say, being chased by a hungry tiger, or simply driving during rush-hour traffic – to trigger a “fight or flight” or “survival” response in your body.   And, finally, cortisol is one of the keys to reducing the body’s inflammatory processes, which is why cortisone shots are so popular as a temporary solution to pain associated with inflammatory conditions.  Cortisone works just like cortisol, essentially.  So drinking coffee during an allergy attack while being chased by a tiger will really stimulate your cortisol levels! 

 Cortisol is what makes blood sugar available to help the cells of your body function.  As it is secreted, sugar is liberated into the bloodstream. To get sugar from the bloodstream into the cells, insulin must be present. And insulin triggers another set of metabolic processes.  So, let’s move over to the doughnuts. Simple carbs such as sugars and “white” foods: breads, cakes, cookies, etc. will quickly enter the bloodstream as sugars and thus raise your insulin levels, so that the cells can have some food. There is insulin, at it again.

 But what if you don’t need the “power” of that sugar in the bloodstream at that moment, and need to just save it for later? Then you will make fat out of it. Belly fat, anyone?

 So what has this to do with testosterone?

 Once you do make fat, our old friend “aromatase,” which is present in fat, is increased because that’s where it lives. Increased fat equals increased aromatase. Interestingly, surges of insulin will increase the activity of aromatase, so you get a double whammy of this enzyme. This is important to note, because aromatase converts testosterone into estrogen at an accelerated rate.

 Let me say that again for emphasis:  Aromatase converts testosterone into estrogen at an accelerated rate!

 So that means there will be less testosterone available for a man to use, and greater levels of estrogen, which is not desirable either. Take a look at the following biochemical feedback loop: elevated insulin levels will increase inflammation in the body. So what does that mean?  Inflammation stimulates cortisol, which elevates insulin, which creates belly fat, which stimulates aromatase, which converts testosterone to estrogen, bringing down relative testosterone levels.  And the cycle continues… Kind of puts coffee and doughnuts in a whole new context, doesn’t it? 

 Also, eating simple carbohydrates stimulates the same feedback loop in the body.  Simple carbohydrates elevate insulin directly, which, in turn, increases inflammation in the body.  Inflammation stimulates cortisol, etc., ultimately impacting testosterone levels in the same way.  And on and on.

 So, what does all this have to say about holistic options for increasing testosterone?  A holistic approach to increasing testosterone levels would be one that addresses the specific causes of reduced testosterone within a specific individual.  Given that most men with low testosterone levels probably are experiencing one of the feedback loops described above, as opposed to an inability of the testes to produce testosterone, some basic tips to balancing endocrine function are to:  reduce stress, reduce inflammation in the body, reduce intake of simple carbohydrates, and manage the process of blood sugar regulation in the body.  This can be achieved through nutritional protocols designed specifically to rebuild the adrenal glands, improve pancreatic function, improve liver detoxification, and improve kidney function.   

 A good start, if you’re considering undergoing testosterone therapy, is to find a Functional Medicine practitioner (www.functionalmedicine.org) who can guide you through the process of assessing the function of the body’s essential processes, and then develop a customized nutritional protocol to help optimize your body’s performance.

“Is Life Worth Living? That All Depends Upon the Liver.”-William James 

So I mentioned earlier that the liver is the dutiful clerk of the body, just going about its work, doing hundreds of tasks which nobody else seems to want to know about or understand, not attracting too much attention, and not getting much credit for doing a good job. It’s always cleaning up everyone else’s messes, and never even asks for a raise. What are we to expect from this overworked civil servant?

 Did you ever wonder why that when someone goes on a “liver detox”, or “cleanse”, they feel really crummy for a week or two? Sometimes they feel better afterward, but many do not, and there is a good reason for this.  Just as there are phases of the moon, going from New to Full and back, and there are phases that teenagers go through where parents go from being heroes to being insufferable dorks, the liver has phases too. Unlike the moon, the phases of the liver are permanent. Consequently you will never hear expressions such as “once in a blue liver”, or a “waxing crescent liver”, or even the autumn “harvest liver”. And it’s a good thing too, because nobody would know what you are talking about.

 Phases of the liver are basically 2 discrete sets of functions that the liver carries out independent of one another, and yet it’s their relationship to one another which determines, at least in the moment, if life feels like it is worth living. Phase I is akin to you taking the garbage out to the curb, and then Phase II is like the sanitation service hauling it away. When speaking of detoxifying the liver, it is important to keep these two phases in mind. During a supervised detoxification program, the individual’s liver function must first be evaluated, primarily by using a urinary evaluation.

 There are several sets of patterns that emerge when making this kind of an evaluation:

1. Both phases are working well and harmoniously.
2. Phase I is working well, Phase II is not working well
3. Phase I is not working well, Phase II is working well
4. Neither are working well

 So guess which one is the worst case scenario. It’s probably not what you think. The worst case scenario is one where Phase I is working well and Phase II is not. If you’ve ever been in New York City during a garbage strike, you will know what I’m talking about here. Especially if it was in the summer. So, the body brings this heavy load of garbage to the curb (Phase I), and then it sits there festering in the sun, smelling worse by the day, attracting flies. If it had been kept inside, it probably wouldn’t be as foul, but there it is, curbside, with nobody coming by to pick it up (Phase II).

 So this is how it plays out: The body wants to get rid of a particular toxin, and pushes it through Phase I, which is an enzymatic transformation, in an attempt to make it easier to remove “nasties” from the body. In doing so, Phase I creates a whole new more toxic toxin out of it, for the sake of setting it up for phase II. So here you are with garbage ripening in the sun and you can’t do anything about because the garbage men are on strike.  And so it is, those Phase I toxic rascals are much much MORE toxic than they started out to be, and the greater the build up, the more miserable you become.

 So this is why your liver detoxification program needs to be aimed at Phase II before it deals with Phase I, so that when you start corralling toxins toward the liver, you don’t end up with all of this messy build up fermenting on the curb, to the irritation of your neighbors and dog walkers alike. When Phase II is dealt with first, it clears the way for Phase I toxins to clear out quickly without the ill effects. Now to me, that just makes good sense; to me anyway.

So when going about “liver detoxification” the liver needs to be treated right, because we depend upon it. Then, life is worth living.

Where does this symptom come from?

 Asking questions like this can be thought of as radical. Really, it’s a very basic question that would seemingly be a common sense thing to ask of one’s self or one’s patient. Clearly, this is not the approach that modern medicine takes toward illness. A doctor should never fail to ask this question. 

There is a fairly good reason for this. Modern medicine, built upon principles specific to an acute care model, has no use for this question. If someone is presenting to the ER doctor bleeding, so long as the knife or glass or bullet is not lodged in the body, the prime directive is to get the bleeding stopped, and appropriately so. The mechanism doesn’t really have an impact on treatment to a large extent.

When dealing with a chronic diseases and issues, utilizing an acute care model is doomed to eventual failure. This is because the fundamental question is never asked. If someone presents with headaches, depression, digestive complaints and huge hormonal swings, the typical medical response would be along the lines of the acute care model; which is sometimes necessary to get a hold on the situation, to stop the bleeding as it were. But more often than not, that is where treatment ends, and consequently the condition does not resolve, frequently worsens, and is further complicated by the treatments applied.

 Using the acute care model is very familiar to us, for the above listed symptoms, the treatment would be something along the lines of:

 Headaches: pain relievers/non-steroidal anti-inflammatories

Depression: one of a variety of “anti-“ drugs

Digestive complaints: antacid/proton pump inhibitor/antibiotic

Hormonal dysregulation: hormone replacement or birth control pills

 Again, in the short term, it is possible that this approach is necessary to get a foothold on the situation, and also in the case where too much damage has been done to the body for it to recover properly. But generally, as a long term strategy they don’t work because the fundamental question has never been asked: “Where does this symptom come from?” Headaches recur, anti-depressants stop working, digestive complaints return as soon as the medication is stopped, and the same can be said for hormones.

 If we get back to basics and dare to ask this question of our doctors, most likely we are met with a blank stare, and the notion that it is not important what caused it, just that it is stopped by the treatment. (If indeed it is.) The response is as such because it’s a question that the majority of doctors of all disciplines were not taught to ask. But asking this question leads us to the cause, and once the cause is found, it can be dealt with.

 There are many causes for each of the symptoms I mentioned earlier, but when they are put together they lead toward a smaller group of possibilities. How those symptoms are understood in the context of one another yields a lot of diagnostic fruit. When they are coupled with the proper standard and functional diagnostic laboratory testing and a thorough understanding of physiology, even the most difficult cases can be effectively treated.

 In general, groups of symptoms which are not understood are called “syndromes”. However, when looking at syndromes, such as Chronic Fatigue Syndrome, doctors recognize a group of symptoms, but completely ignore many more that don’t “fit” the concept of what that particular syndrome is. Unfortunately what this means is that the diagnostic net has not been cast widely enough in order to take in all the factors contributing to the underlying problem. Thus the syndrome remains.

 Unfortunately most doctors are not trained to thoroughly understand physiology (how the body works), just pathology (disease categories) and in a narrow range of specialization at that. So our fictional patient above will go to the headache doctor, the psychiatrist, a gastro-intestinal specialist, and an endocrinologist because each of the symptoms is thought to be an isolated entity unrelated to one another.

 Understand however, that the body is a whole, and everything affects everything else. As an example, a patient presents with aching back and burning foot pain, a shifting of balance and posture, elevated blood pressure and cortisol (the stress hormone), systemic infection, loss of appetite, and inability to sleep. Imagine seeing a specialist for each of these symptoms! But this is what happens…all the time. What is required is someone to step back and ask: “Where did these symptoms come from?” It is only from that standpoint that we can begin to address chronic poly-systemic illnesses. If there is one who can understand the altered physiology and the interrelationship of these symptoms, then it is much easier to look at this patient and say, “All of your symptoms relate to this infected thorn in your foot.”

 Functional Medicine doctors are at the forefront of asking the required questions, and making the connections between seemingly disparate aspects of our health problems. As common sense as it would seem to the lay person, it is a radical departure from the mainstream way of thinking, and is consequently marginalized to a degree. But the time is coming when this kind of doctor will emerge from relative obscurity into one that becomes everyone’s primary care doctor, freeing up the specialists to deal with the acute problems they have trained to properly handle. They are now, and increasingly will be the ones who answer this and other important but as of yet neglected questions.

An argument for Holistic Medicine

We interrupt the previous stream of consciousness to bring you the following special bulletin:

CFS: “I’m so misunderstood.”

One thing I have noticed with patients who have Chronic Fatigue Syndrome (CFS) is that many times they have been lead to believe that there is one cause. While being assessed and treated for CFS, doctors usually only look for the one cause that is particular to their education. They educate the patient that it is just a matter of finding the Epstein-Barr Virus or the XMRV virus and then it is a matter of treating symptomatically…or leaving it alone for that matter.

Truthfully, in the typical medical practice, there really isn’t much to do other than treat symptomatically anyway. Even from the perspective of the doctor of natural health, many times the same approach is taken, and treatment is to give this or that particular remedy which is generally one that is related to reducing symptoms.  But to truly address the problem, it doesn’t really work that way. The reason why is that there is more to the story than just symptoms.  There is the matter of cause.

It is indeed fortunate if the one cause for the person’s symptoms of CFS happens to be the one thing that is looked for and found by that particular doctor. Even then, it can be a long road to recovery. This is mainly because most treatments are as I mentioned earlier, aimed at treating symptoms. What needs to be found are the causal factors, and those factors need to be, to the best of our ability, neutralized.

 The thing is, Chronic Fatigue Syndrome is caused by a variety of factors, not just one. And it is the predispositions of the patient from genetic, environmental, and circumstantial perspectives that determine which factors contribute to the overall health (or lack thereof) picture.

 I have prospective patients call up and ask me how long it will take to get them better. With CFS, the best answer I can give is: “it depends”. In general, the answer is dependent upon what and how long the problem has been there, how much damage has been done, how willing the patient is to change their lifestyle, and desire to comply with treatment regimes. Many medical treatments are the same regardless of the cause, regardless of the many contributing factors. Thus, the answer is frequently something like: “we will do a course of this drug for six weeks…”. But the answer as to how long it will take to overcome CFS for any given patient is entirely dependent upon the patient, not on some stock treatment protocol.

The fact is that Chronic Fatigue Syndrome is misunderstood by many, by the patient and by the doctor alike. There is not one cause, and consequently not one cure. We can’t be sure how long it will take to get any one individual better because it’s complicated! It’s complicated because it’s like finding 6 needles in a field of haystacks. However, most times, the answers can be found when we know what we are looking for. Being a doctor who has had Chronic Fatigue Syndrome in the past, I know what I’m looking for.

 So if you are a sufferer, take heart in knowing that there is someone who understands that it’s not all in your head. Like CFS, you no longer need to remain misunderstood.

 So back to the Abs of Stool phenomenon. Rarely in practice do I see any symptom that has only one cause. Abs of Stool is no exception. Frequently however, what I see is that in the case where there is symptoms of reflux, is there is not enough stomach acid. WHAT? Yep. Not enough stomach acid. Well why would someone have sensations of burning in their stomach if they didn’t have enough acid? I mean, isn’t an antacid used because there’s too much acid? And it feels better when you take them too?Think of it this way, if the normal process of digestion is compromised, and there is insufficient acid in the stomach, what will begin to happen is putrefaction. Rotting. So let’s say you eat a big juicy hamburger, and it’s sitting in your stomach without enough acid to break down those tasty proteins.

What happens now? Think of your garbage disposal…after a while it starts to stink if you don’t run some lemons through it. The guy with the gut sticking out in front is frequently one of those people who get a little too close to you when you’re talking with him, or isn’t the guy you want to share a gym locker with.

 When there’s not enough acid in the stomach, and you get all of this putrefaction going on, then when the food moves into the small intestine, there’s nothing to tell the pancreas to add it’s two cents. By the way, those two cents are very important, they are called enzymes, normally triggered by the acidity of burger under normal stomach circumstances, and they are responsible for the next phase of digestion.

 But I’m getting ahead of myself. Meanwhile, back at the stomach, the insufficiency of stomach acid and the putrefaction of that burger has created a bunch of organic acids which are not normal in the stomach, and THAT is what for many creates the burning…and a bunch of other problems too. OK, so the protein laden burger has not broken down properly in the stomach and created a burning soup of rotten food. Then into the small intestine where the pancreas can’t really do it’s job.

 This is when things get ugly…

Oh, I wish I could take credit for the title. My lovely wife, Kelli came up with that one. Once I stopped laughing, I realized how this phenomenon is seemingly everywhere!

You’ve seen him…or maybe you ARE him…the guy walking down the street with the big gut sticking out. He’s got skinny arms and legs, they may even be muscular, but that gut is sticking straight out, and it’s firm to the touch. Well, it would be firm to the touch if you were so inclined to touch it, which chances are you are not, unless of course you are that guy. Beware gentlemen!

What you are looking at is not likely fat. Fat is jiggly. This isn’t jiggly, it’s like a bowling ball. In all likelihood, this guy has the dreaded “Abs of Stool”. In this case, the digestion has taken a vacation. There’s a lot of undigested food hanging around in there, and it’s going to cause problems down the road too, and in places other than the digestive system.

Some guys like this will say that they don’t have any problems with his digestion. What he means is he doesn’t have a lot of burning or similar symptoms. And that may be true. More often however, is that there are symptoms like gas, constipation, and of course acid reflux. Big pharma has a field day with acid reflux. Just look at how many antacids are on the market. Greater than $13 billion is spent on antacids in this country annually. And up to 100 million people in the USA annually, suffer from symptoms of indigestion (and are treated or treat themselves with antacids)…and those are just the ones with acid reflux.

Seriously, $13 billion! That’s only antacids. We’re not talking diarrhea, constipation, cramping, or other gastrointestinal symptom relievers/preventers. This is not a good situation. So what are we looking at here? And we all know that men don’t complain about health issues very often. “Oh THAT finger? Didn’t need that one very much anyway”.

So, what are these abs of stool all about? Stay tuned…

I was invited by the fine people in charge of the Parker College of Chiropractic Nutrition Club to speak yesterday on the topics of Essential Fatty Acids and Histamines. Thank you Cari and Kyle! The talk was designed for the professional or professional student to use this information in a clinically applicable way. The audience was very much engaged in the discussion. The first question I asked was, “What is the most important thing you can do with your patient?” after a volley of answers, I reminded them that the first and most important thing you can do is to LISTEN! It seems like doctors are trained poorly in this department, so it is always good to reinforce this critical point.

Another question I asked was, “Which is better Omega-3 oils or Omega-6 oils?”, and everyone answered “Omega-3”. I suppose a lot of people have asked themselves this question when going to pick out supplements from the shelves of their favorite health food store.

The real answer is that they are both very important, but they need to be balanced. Despite popular press, Omega-3’s (fish oils) can also become a problem if the levels are too high in the body. The lesson here is that more is not better when it comes to clinical nutrition. It’s also interesting to note that combinations of Omega-6’s and Omega-9’s can be very clinically important in many ways.

So our little discussion revealed how we can, using the techniques of Applied Kinesiology, and understanding the biochemistry, determine with a reasonable degree of certainty which oils or their vitamin/mineral cofactors are going to be of greatest benefit to the patient RIGHT NOW.

The best part is that can use this method to start putting out the inflammatory fire while we are waiting for our lab work to tell us from a more objective and comprehensive viewpoint, any other issues that need to be addressed from a Functional Medicine perspective. While time was very limited, all of us biochemistry geeks bonded and had a productive time overall. I look forward to speaking again to the Nutrition Club in the not too distant future.

In the mean time, I will be working on developing weekend seminars which address these issues and many others from a more comprehensive view. It seems that Natural Medicine Doctors, Functional Medicine Doctors, Functional Neurology Doctors, and those of us in the healing arts in general need to lead the way in the integration of science with common sense and ancient wisdom.

I will be blogging, hopefully on a regular basis, about the many of the strange and wonderful things I see in my practice, how I deal with them, and the outcomes. Hopefully it will be of interest to those who have had difficult health issues and no answers. It is something that greatly interests me because I was that someone.

Years ago, I ended up with Chronic Fatigue Syndrome (CFS), or what is now known as Chronic Fatigue Immune Deficiency Syndrome (CFIDS) and even by the newer and more esoteric name Myalgic Encephalomyelitis (M.E.). I also had severe food sensitivities and Multiple Chemical Sensitivities (MCS) as well. Back then, there was not even a name for all of these disorders, much less even a recognition that they even existed. Well, I KNOW they exist. I had a fever for several years and also had all of the nasty other symptoms that come with these debilitating conditions. Unbelievably, many doctors still believe it is all in the patient’s head. I suppose sometimes it is, but an overwhelming majority of the patients I have seen have been the real deal. I’ve even had to treat one patient in her car, as she was too weak to get out. 

So I’ve become a CFS doctor, or CFIDS doctor, or even an M.E. doctor if you will, because of my personal experience and battle with those symptoms. And I will tell you that it can be overcome! IT CAN! I have done it! I have not had any symptoms or sign of the underlying condition for a long, long, time.

I will tell you that there is no one thing that works for everyone. There is no one cause, there is no one fix. Despite trying to nail down a specific cause or specific virus, such as Eptstein-Barr Virus (EBV) many years ago, or the newer discovery of xenotropic murine retrovirus (XMRV), I don’t believe ONE cause will ever be found. My patients have very complex poly-systemic issues which all have to be dealt with at the right time and in the right ways. I had to learn how to do this the hard way. I know what it’s like, and I know what it takes to get better. There is no “magic bullet”, but it can be done. 

Please check out my practice at www.hearthstonecenter.com and feel free to call me if I can help you.   -Dr. Jac