Dr. Stram Takes Your Questions on Probiotics

Ron Stram, MD

We often think of “bacteria” as harmful; avoiding any situation that we may have potential contact by disinfecting, cleaning and sanitizing. But, in actual fact, we as humans have a complex and necessary relationship with beneficial microbes that function to maintain and prevent diseases. In our intestines, live trillions of organisms that are so vital to our health and survival that some consider them an organ itself. Along these lines, genomic identification of specific beneficial bacteria present in our own gastrointestinal tract, has just begun to be fully understood in its importance in treating a host of diseases. The use of “PRO-BIOTICS” in the treatment and prevention of disease is part of the new medicine frontier that looks to utilize the human bio-landscape as a source of immune enhancement and self healing. I am frequently asked questions about probiotics by my patients. Here is a summary of these FAQ’s:

What exactly are probiotics?

Probiotics are beneficial or “friendly” bacteria that help to maintain the health of the intestinal tract and aid in digestion of food. These bacteria resemble the natural flora that line the gastrointestinal tract. There are many probiotics; some common examples are: acidophilus, lactobacillus species, bifidobacteria, and yeast forms such as saccharomyces boulardii.

What do they do? How do they work? What is their benefit?

Probiotics aid in the digestion and absorption of proteins, fats, calcium, and phosphorus. In addition, probiotics together with the gut flora help keep potentially harmful organisms in the GI tract under control. They act to enhance the immune system by preventing the growth of harmful disease causing bacteria and yeasts. Probiotics are thought to work in this way by growing within the small intestine and crowding out disease-causing organisms, thereby restoring proper balance to the intestinal flora. They successfully compete with harmful organisms for their nutrients, therefore taking probiotics as a therapeutic aid can be a natural defense against preventing and treating certain diseases. There is strong and solid evidence to support the effectiveness of probiotics in preventing and treating diseases such as:

- Antibiotic related colitis (profuse uncontrolled diarrhea with cramping)
- Stomach ulcers (cavities in the stomach caused by helicobacter pylori infection that cause pain and / or bleeding)
- Diarrhea prevention in both children and adults
- Infections both gastrointestinal and respiratory
- Irritable Bowel Syndrome  or IBS ( a condition in which the bowel appears normal but does not function normally; associated with abdominal pain, cramping, bloating and both diarrhea and constipation)
- Dental Cavities
- Eczema in children (inflammation of the skin which becomes red, flaky and itchy)
- Sinusitis (infection and inflammation of the air passages of the face)

Can they be harmful?

Probiotics are usually well tolerated with no adverse symptoms. The most common side effects are gas and bloating which usually resolve after a few days from onset of usage.  There are rare reported cases in severely compromised patients with very low immune system function who have developed an infection from the probiotic itself.

Should everyone take them?

In our society, antibiotic therapy is common; there are antibiotics in our hand creams; cleansers; food sources such as meats and dairy products. Antibiotics are overly prescribed for common nonbacterial ailments such as coughs and colds. Except for those people with very compromised immune systems, daily intake of live “friendly” bacteria in food sources such as yogurt can be helpful in gastrointestinal irregularity. For prevention and treatment of specific disease states, proper dosage of probiotic therapy not found in yogurts such as Activia is recommended.

It is my recommendation that anyone given antibiotics for the treatment of disease should also be taking probiotics to help prevent antibiotic related ailments such as diarrhea. The probiotic in proper dosage, should be taken 2 hours away from the antibiotic.

In what form?  

Some probiotics come from food sources, especially cultured milk products such as yogurts. Probiotics in therapeutic formulations can be consumed as capsules, tablets, beverages and  powders which can be added to other foods.

Are certain strains better than others?

Testing has shown that certain strains have proven more effective for specific diseases state. For example: Lactobacillus GG in particular, is effective as treatment for rotavirus diarrhea in children.

What are your thoughts on Activia and the 14-day Activia challenge?

Activia is a fortified probiotic yogurt which contains lactobacillus and bifidobacteria. It is thought that by increasing one’s gut flora with more beneficial bacteria such as that contained in Activia, digestion and bowel habits will improve. Activia is only one source of probiotics and from a therapeutic standpoint, its concentration is too low to act as a treatment option for disease states. However it can be helpful in regulating ones daily bowel habits.

Do probiotics really improve health or is this a marketing scheme? 

In my practice I have used therapeutic probiotics effectively for the past 8 years in the treatment of IBS, chronic sinusitis; prevention and treatment of antibiotic related diarrhea; ulcers; reflux and general digestive disorders. The most important therapeutic aspect is proper dosage and course of treatment. The market is taking advantage of what has been known for many years in the integrative medicine community. One can see an analogous approach to the marketing of fish oil in the prevention of heart disease.

Is taking Activia or similar products merely a placebo?  

No; the presence of live beneficial bacteria does not act as a placebo. However, dosage and duration of treatment must be adhered for management of specific disease states.

Are there recent studies that back up these hypotheses?

YES. There are numerous studies reported in the medical literature that support the use of probiotics in the prevention and treatment of specific diseases.

What's the difference between Probiotics and pre-biotics?

Pre-biotics are complex sugars such as fructo-oligosaccharides, lactulose and inulin that are used as fuel for healthy bacteria (probiotics) to stimulate their growth in order to maximize their population and minimize or prevent the growth of harmful bacteria which do not thrive on these  sugars. Pre-biotics can be found in Japanese miso, kefir, raw milk, tempeh, bananas, garlic and onions.
 
 What dose is recommended?

The dosage of  pro-biotics is dependent on the disease being treated, including the daily amount and duration of treatment. When the goal of treatment is to replace gut flora in a patient who has, for instance IBS,  the minimum duration of treatment is typically 12 weeks coinciding  with the lifespan of digestive cells. If the goal of treatment is to just improve minor intestinal irregularities, then 2 weeks can prove to be sufficient as in the case of the Activia challenge.

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Stories from the Center

“Eight Years Ago” – A Letter from Terri

At the Center, our patient-practitioner relationships often run deep. Sometimes, after a long time has elapsed since last seeing a patient, we’ll ask, “I wonder how (so & so) is doing?” Here is a recent letter from Terri, a dear patient from eight years ago:

September 23, 2010

Dear Dr. Stram, and the CIHH Staff,

I came into your practice about eight years ago suffering from severe panic and anxiety. I had gone from doctor to doctor with no relief, and I had reached a point where I no longer knew where to turn.

I remember my 1st visit very well. I was sitting on the treatment table with three of you gathered around me – Dr. Stram, Chris, and the naturopath who was working for CIHH at the time - I was bright red, I was crying, I couldn't focus - I was really suffering.

You guys were wonderful - Chris treated me 3x a week and I had some one-on-one consultations as well. I remember struggling just to leave the house and drive to my appointments. My anxiety was so severe.

Thanks to your treatments, I was able to pull myself together and heal without medication, which was my goal.

I tell my story about my success with CIHH all the time. I just gave your number to a friend here at work, and I thought I would write you to tell you that I now weigh 100 lbs less, I am no longer married, and I am raising three beautiful girls on my own. I am living a healthy, full and spiritual life – completely and 100% free from any anxiety or panic.

Thank you so much - I would never be where I am today without your help and support.

Sincerely,

Terri BZ

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Acupuncture Successfully Treats IBS

Rebecca Rice , Licensed Acupuncturist

Treating digestive disorders such as IBS is one outstanding forte of acupuncture. In Chinese medicine the body is seen as a complex and integrated system, where one organ function influences another. If one organ system isn’t operating up to par, this will negatively impact other organ systems.

The liver is one such organ that when hypo-functioning due to stress, buildup of toxins through pharmaceuticals, pesticides or other chemicals, can detrimentally affect digestion, causing symptoms such as those experienced with IBS: abdominal pain, gas, bloating, diarrhea, constipation, and frequent or infrequent bowel movements.

According to Chinese principles, acupuncture can soothe the liver which aids in both physical and mental detoxification. Acupuncture can also expel wind, in other words, relieve spasms of the bowels. Acupuncture can thereby help the digestive system work more effectively, reducing pain, gas and bloating as well as normalizing bowel movements.

Extensive research supports the use of acupuncture for IBS. Electro-acupuncture has been shown to inhibit the proliferation of mucosal cells in the colon and deter the over-secretion of neuropeptides in the colon which lead to spasms. Acupuncture has also demonstrated the effect of reducing abdominal pain after a series of sessions for extended periods.

If you are experiencing the painful discomforts of IBS or other gastrointestinal problems, give acupuncture a try. Together with a good nutritional plan, acupuncture will help you regain your health and vitality.

The Area’s First Community Acupuncture Program

The Center now offers the first Community Acupuncture program to help those who otherwise find acupuncture unaffordable. With limited insurance coverage for acupuncture in New York, we felt on a very personal level the difficulty that many in our community had in affording a form of healthcare that is solidly supported by research and highly effective. Quality healthcare shouldn't be reserved for the wealthy. With that in mind, we have incorporated the most affordable method of delivering acupuncture in the country, putting the cost significantly lower than any other acupuncture provider in the area without sacrificing the quality and professionalism that the Center has become known for.

For more details on community acupuncture and other resources at the Center, please give us a call or just drop by to speak with our devoted and friendly staff.

References:

Dig Dis Sci. 2008 Jun;53(6):1644-51.
Regulatory mechanism of electroacupuncture in irritable bowel syndrome: preventing MC activation and decreasing SP VIP secretion.
Wu HG, Jiang B, Zhou EH, Shi Z, Shi DR, Cui YH, Kou ST, Liu HR.
Shanghai Institute of Acupuncture-Moxibustion and Meridian, 650 South WanPing st., XuHui, Shanghai 200030, P.R. China. wuhuangan@citiz.net
J Gastroenterol. 2006 May;41(5):408-17.
Acupuncture for functional gastrointestinal disorders.
Takahashi T.
Department of Surgery, Duke University Medical Center, Durham, NC 27705, USA.
J Neurogastroenterol Motil. 2010 Jul;16(3):306-14. Epub 2010 Jul 26.
Effect of electroacupuncture on visceral hyperalgesia, serotonin and fos expression in an animal model of irritable bowel syndrome.
Wu JC, Ziea ET, Lao L, Lam EF, Chan CS, Liang AY, Chu SL, Yew DT, Berman BM, Sung JJ.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.

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What Qigong Can do for You

Sue Coughtry , Licensed Massage Therapist, Advanced Reiki Master

What is Qigong?

More and more people are practicing qigong (“chi-gong”) these days and finding that it helps them stay healthy and to recover from illness and injury. Qigong is a Chinese moving meditation and art that is thousands of years old. There are many kinds of qigong- sitting qigong, standing qigong, walking qigong. They all involve using the breath and the mind to move energy (qi,chi) more smoothly along the pathways or meridians of the body. Tai chi is a moving form of qigong that has a martial arts element to it.
The movements of qigong are slow and meditative. The breathing is deep. It doesn’t take long before you can feel heat and tingling in your hands, and with time you can feel it in other parts of your body. The goal is to learn to move the energy to where you want it to go. That can take years, but just a simple, regular practice of qigong can have profound healing effects in a very short time.

How Qigong Can Help You

The practice of qigong calms the nervous system immediately, which lowers blood pressure, allows deeper breathing, calms the heart rate, and helps reduce and remove the effects of our very stressful lifestyle. The majority of our illnesses today are either caused or exacerbated by the stressful way we live. Qigong can be that peaceful reprieve to calm down and relax.
It also doesn’t take a lot of time to incorporate some qigong into your life. While there are many levels to qigong – it takes a lifetime to master – the simple movements and breathing bring health benefits right away, even to beginners. How far you delve into this practice is up to you. Most people are happy just doing the movements and breathing.

My Personal Qigong Practice

The qigong that I practice, and I practice several different styles, involves simple moves coordinated with breathing that opens up the meridians (the energy channels), and allows the healthful energy to flow more freely. I feel the energy start to move as soon as I start. I do a couple short routines and a longer one. The short ones can be done several times each when I feel like doing a longer session. I can also use my hands to direct the energy in a more focused way when I want to. I find it calms me whenever I am tense, and it also helps me sleep better if I do a little qigong before bed. It’s something that can be formal or informal; it’s very versatile. Even doing just one move over and over with the breathing can give you a few minutes of peace and calming in a hectic day. It’s amazing how such a tiny thing can transform a day, or a life.

Qigong Classes Coming to the Center this January

Qigong really can’t be learned from a book, but the basics can be picked up on a video. You get better results when you have instruction, at least to start with. I will be teaching qigong classes starting in January at the Center on Monday evenings, so if this is something that interests you, please check our classes page or call at 518-689-2244 for more details.

Qigong is such an easy and simple way to enhance your health and healing. See what it can do for you!

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Fighting Off Colds This Fall and Winter

Korey DiRoma, Naturopathic Doctor

It's that time of year again when the weather becomes colder and kids go back to school. This means that more time is generally spent indoors and kids’ exposure to germs is greatly increased. What can we do to limit our exposure and increase our own defenses?

Hand washing is always very important. Most of what we "catch" are viruses that come from exposure through the air or direct contact via our hands that often cause colds, upper respiratory tract infections, sinus infections, or the flu. There is not a lot we can do about air exposure other than covering your mouth when you cough or sneezing into your arm.

What happens when we don't wash our hands? The virus sits on our hands until we wash them off. Otherwise when we touch our hands to our eyes or our mouth, or eat foods with our hands, the virus gains direct entry into our body. If there is enough of this virus and our immune system is susceptible, we will then get "sick". However, because our eyes, nose, mouth, lungs, and intestines are all exposed to the external environment and therefore non-sterile, we have many natural defense mechanisms including specific immune cells.

How we can help increase our natural defense mechanisms

Probiotics makes the scene once again. Probiotics such as Lactobacillus acidophilus and Bifidobacteria help to increase our natural defenses in the gastrointestinal tract. This acts to regulate the immune system by increasing “barrier function”, lowering susceptibility to "bad" bacteria, and decreasing inflammation.

Probiotics are found in fermented foods including: yogurt, kefir, aged cheeses (not baked or processed), and buttermilk. Other non dairy sources include fermented soy products such as miso, soy sauce, tempeh and ferment cabbage such as sauerkraut (read label, some do not) and Korean kim-chi. If these foods are not part of your everyday diet, then I would suggest supplementing with probiotics over the fall and winter months.

Vitamin D. Vitamin D has many health benefits, but here, I will focus on its importance in immunity. Vitamin D is involved in the production of antimicrobial peptides called defensins and cathelicidins. These peptides provide a natural defense to microbes, or "germs", in the respiratory tract. Low vitamin D is associated with increased respiratory tract infection (colds, sinus infections, bronchitis, etc.).

Sources of vitamin D include high intensity sun-light, and foods such as fish, meat, egg yolk, and mushrooms. Certain foods are also fortified with D and include milk, milk substitutes such as “rice dream” and soy milk and most commercial cereal, cheese and butter.

Here’s to a healthy Fall and Winter, cold –free!

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Integrative Medicine for the Young

Christopher Reilly, Licensed Acupuncturist

Clients are often surprised when I tell them the youngest person I've ever treated with acupuncture was just a couple of weeks old. There are tui na (acupressure) techniques and acupuncture techniques where specialized needles which are not inserted are used to help younger children with a great variety of health challenges. It has been my experience that younger patients often respond to treatment more quickly and more completely than many of my older clients. I feel that it is important to emphasize that integrative and complementary healing tools should not be seen as strictly for adults. Recent recalls of children's cough and cold medicines are a worrying wake-up call for those of us who occasionally take the strictly pharmaceutical road in the care of our children.

The very best time to begin incorporating healthy eating habits is during the early years. With childhood obesity and chronic illnesses such as type two diabetes and cardiovascular illness now showing up in the under 18 crowd with increasing frequency, this lesson needs to be brought into the home more than ever. The challenges faced by a generation raised from birth on food additives, preservatives, and over-consumption will be considerable, so let's do our best now to prevent them.

A great many herbal medicines- the majority of them- are also safe to use in younger patients, with an appropriate adjustment of dosage. Just like diet and acupuncture, herbal medicine isn't just for the generation x'ers and over. In some cases, we have to be inventive with how the herbs are delivered. I've had clients obscure probiotics in yogurt and disguise yucky powdered herbs in flavorful smoothies, it just takes a little creativity like most other areas of parenting! Homeopathic herbs are probably the easiest, as they are often delivered with a sugary pill that can dissolve in the mouth without needing to be swallowed.

We as adults typically try to avoid medications when healthy alternatives exist. It may take a little extra effort, but let's give that same gift to our children! As always, if you have questions as to whether there are complementary therapies that would benefit your child or children, or concerns about the safety of natural medicines for children, we are always happy to answer your questions.

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A Tribute to Vitamin K

Jennifer Enos, Nurse Practitioner, Holistic Primary Care

I learn from all the people around me. One important group of people I learn from is my patients who have so much knowledge about their bodies. Our learning relationship is a dynamic one, so as I keep up with the latest information in regard to health and preventative medicine it is my privilege to teach my patients about their options for achieving optimal health. Here is good news to share in integrative and holistic medicine on an important role of Vitamin K in healthy bone growth.

Vitamin K is well known for its role in blood coagulation, but it’s importance in bone health is becoming better known in complementary circles, and will at some point make its way into mainstream medicine. Rather than being a single nutrient, Vitamin K is a group of several nutritional compounds that are produced within the body; the good bacteria in your gut produces about 75% of the K and the rest is gotten through diet. Vitamin K deficiency is not very common in adults with healthy gut flora and also because K is found in a wide variety of foods. Nevertheless, as Vitamin K is not stored by the body, supplementation or diet is important. The different forms of Vitamin K have different effects in the body. For the purpose of this article, I am addressing Vitamin K2 only.

Healthy Bone Growth : The Dance between Vitamin K and Vitamin D

What is being found in studies is Vitamin K is best utilized along with Vitamin D for bone growth. An unexpected discovery was made by scientists in that blood vessel cells can transform into bone forming cells. This is an important link between osteoporosis and atherosclerosis.
What has been found is that osteoporotic people also have calcification in their blood vessels or atherosclerosis and those with atherosclerosis tend to have lower bone mass. What both groups have in common is insufficient Vitamin K.

More evidence is showing that there is a playful dance between Vitamin D and Vitamin K2 and how they operate synergistically to combat osteoporosis and atherosclerosis.
One study which took place in the Netherlands involved 4,800 subjects that were followed for 7-10 years. This study showed that people with the highest 1/3 of K2 intake had a 57% reduction in risk of dying from cardiovascular disease compared with those who had a reduced intake. (1)
Another study looked at women who had Parkinson’s disease and all patients were found to have low Vitamin D and K2. The women were supplemented with 45mg of K2 a day and after one year the bone mineral density in their hands had increased significantly compared to the women who were not being supplemented and the women in the placebo group were 12 times more likely to sustain a fracture than those in the Vitamin K group.(2)

Much has been in the news about Vitamin D3 but few supplement takers understand the role of K2 also and the critical need to take it along with Vitamin D; 45 mg per day should suffice.

Here’s to a happy, long fulfilled life.

References:
1. Bostrom K., Watson KE, Horn S, Wortham C, Herman IM, Demer LL. Bone morphogenetic protein expression in human atherosclerotic lesions. J Clin Invest. 1993 Apr,91(4):1800-9.
2. Sato Y, Honda Y, Kaji M, et al. Amelioration of osteporosis by nematetrenone in elderly female Parkison’s disease patients with Vitamin D deficiency. Bone. 2002 Jul:31(1):114-8.

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Yoga & Meditation Corner
Pranayama: the Art of Breathing

Jim Whiting, Certified Kripalu Yoga Instructor

We often overlook one of the most powerful and healing tools we have: the simple act of breathing. In Yoga we call this Pranayama. Our breath can change our mental and emotional outlook, relieve tension, and keep the mind/body healthy.

Breathing can regulate your emotional state in seconds. For example, when we are upset or disturbed, we chest breathe, which is a natural fight or flight reaction of the body. Because of the stressful lives many of us lead, this has become our habitual way of breathing. We should be breathing from the diaphragm. Stop reading and check: how are you breathing at this very moment?

Breathing diaphragmatically moves the carbon dioxide that sits at the bottom of the lungs, because it is heavier. Breathing diaphragmatically, we not only move out the carbon dioxide, we move out of the fight or flight breathing response and we begin to relax the bodies systems.

Here is a simple Pranayama exercise you can do at anytime:

1. Notice the flow of your breath, are you chest breathing?

2. On the inhalation, let your belly fill on all sides like a bowl. Let the inhale be gentle passive.

3. On the exhale, push your bellybutton back toward your spine and slightly up, moving the last bit of air out of the bottom of the lungs.

4. Continue to actively engage the diaphragm on the exhalation, let the inhalation be natural.

This simple exercise can start to calm the mind almost immediately. We should be breathing this way all the time, but it can take some practice. As babies we breathed diaphragmatically, but as adults we have forgotten how. Remind yourself to breath from the belly. Stop and notice your breath when you are upset; breathe diaphragmatically and notice the change.

At the Center, our yoga and meditation classes focus on learning to re-connect with our breath and techniques using the breath to bring us to a place of calmness and peace. We learn how the simple overlooked act of breathing can help navigate our modern stressful world.

If you are interested in joining our yoga or meditation classes, check our Classes page for the schedule.

In November, I will be teaching a workshop on Pranayama. See our Classes page for more details.

Come and learn to breathe freely with us.

Namaste, Jim

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What's New in Holistic Medicine at the Center

"Scenar" Treatment for Pain Now Available at the Center

SCENAR is a hand held medical device that delivers non invasive, non toxic, computer modulated, therapeutic, electro- stimulation onto and through the skin. It is a biofeedback device involving no drugs and no surgery that prompts the body’s own self healing process thereby reducing stress and inflammation and effectively changing symptoms of pain and dysfunction. Its effectiveness is well documented; and consequently the FDA has approved it for pain relief, muscle re-education and stress reduction. The Center’s staff is currently being trained for certification in scenar therapy and will be treating patients starting in November. Call to make your appointment.

Expansion of Holistic Primary Care Services and Homeopathy

Addressing the growing desire for integrative and holistic medicine, all of us at the Center are excited about being joined shortly by a new holistic primary care physician as well as an additional holistic nurse practitioner who also specializes in homeopathy. Please look for our special welcome letter soon!

Natural Standards Database

Being well educated is an essential component to being proactive in your own healthcare and makes for a successful partnership with your practitioner. We invite you to explore and expand your knowledge on our Natural Standards Database where you can research herbal supplements, conditions and remedies.

Community Acupuncture Clinic Now Open at the Center

After extensive research and consideration, we now are able to provide an exciting and effective solution to the financial restrictions felt by many seeking acupuncture therapy. We are proud to be the first facility in the Capital Region to offer COMMUNITY ACUPUNCTURE.

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New Classes and Workshops

Pranayama Workshop: The Art of Breathing

Learn to Harness the Power of Your Breath
Taught by: Jim Whiting, Certified Kripalu Yoga Instructor, Reiki Master

When: Sunday November 21st 10:00am-3:00PM (lunch break 12-1PM)

Where: Center for Integrative Health and Healing: 388 Kenwood Ave, Delmar, NY Fee: $65.00

How: Please call to register: 518-689-2244. Space is limited.

Explore and learn to use the breath to: Relax, De-stress, calm the nervous system, lower blood pressure, energize, focus and increase clarity. See classes page for more details.

New Starting in January: Qigong Classes

Qigong is a Chinese moving meditation and art that is thousands of years old. More and more people are practicing Qigong and finding that it helps them stay healthy and recover from illness and injury. Classes ar taught be the Center's Sue Coughtry, LMT who has followed a Qigong practice for many, many years.

When: 6 Mondays: January 24, 31; February 7, 14, 28; March 7

Where: Center for Integrative Health and Healing 388 Kenwood Avenue, Delmar.

Fees: $15/ drop in; $42/3 classes; $72/6 classes

Reiki Certification Classes

Each class offered is a one day workshop. Each student will be given a course manual and a certificate of completion at the reiki level attended.

Check soon for start of new sessions coming in January!

Reiki II : Oct 30. Saturday class, noon to 6pm

Fee: $150 per class. If taking both the Reiki Master and Teacher level courses: $275 for both classes.

Space is limited to 10 participants. Registration is required by calling our office. Please call: 518-689-2244.

Classes taught by Center staff, Sue Coughtry, Licensed Massage Therapist and Advanced Reiki Master Teacher and Rebecca Rice, Licensed Acupuncturist and Reiki Master.

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Announcements:

- Erica and Nadine and all of the practitioners at the Center are so pleased to welcome Monique Audino and Dolev Melamed. Monique and Dolev have worked hard to learn the ropes and assist with our office management as we continue to expand our services to our patients.

- We are now on FACEBOOK. Become a fan, write a comment share us with your friends!

- Saturday massages are now available with Sue Coughtry, LMT. Start your weekend with a therapeutic massage and let the stress of the week fall away.

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