VOL 16 / Issue: #4 / Autumn 2020 View as Webpage

Paradise Valley Medical Clinic
Douglas M. Lakin MD
9977 N 90th Street, Suite 180
Scottsdale, AZ 85258
480.614.5800 (Ph)
480.614.6322 (Fax)
Updates with Doctor Doug
COVID-19 News
TOP PODCAST DONE WEEKLY
BY DR. MICHAEL OSTERHOLM
(UNIVERSITY OF MINNESOTA)  
 
Dr. Osterholm is a world-renowned epidemiologist who was credited with first elucidating TOXIC SHOCK SYNDROME in the 1980’s, and he provides comprehensive and understandable/actionable ideas related to COVID.

Connect with all of
Dr. Osterholm Podcasts
Office Staff Transitions
To All My Patients:

I would like to introduce, Marlene,
my new office manager.
Marlene has 20+ years experience, and we are very happy to have her join us.

Nan, my administrative advisor and previous office manager, will resume the office manager duties virtually until Marlene comes on board mid-October.

As some of you may know, Leslie has accepted another position with another practice.
I wish to thank Leslie for her great work these past six months, helping us make it through the difficulties of COVID-19, as we all learned how to manage during this challenge to keep everyone safe and healthy. 
 
Please join me in wishing Leslie best wishes in her future endeavor, thanking Nan for holding down the fort, and welcoming Marlene to the practice soon!

Your in good health,
Dr. Lakin
Introducing Wendy
My New Medical Assistant
Please join me to welcome Wendy, my new medical assistant.
Wendy comes to us with much experience, and we look forward to working with her.

Yana, Debbie, and Wendy will be working together to serve your medical needs while in the office.
Welcome Wendy!
PVMC's Flu
Vaccine Clinic
The best way to prevent the flu is by getting vaccinated each year. This is especially important this year because of COVID-19.

Dr. Lakin highly recommends getting your flu vaccine now to have full coverage for our Arizona flu season.

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications.

For the 65 and over set, the high-dose flu shot is recommended. The high dose provides a boosted immunity in the older crowd, resulting in better protection.

We also have the Flubok (4 flu strain coverage, egg-free) for ages 18 and over.

For more information about this year's flu vaccine CLICK HERE
Do You Sleep With Your Eyes Open?
You would be surprised how many of us do!
You walk over to your friend who is asleep on your couch, snoring away. You bend over to goose him when suddenly you jump back in shock.
His eyes are open. Wide open. Yet he's asleep.
No, you're not dreaming. It's not a horror film, nor a flashback to "A Clockwork Orange."

It's a condition called nocturnal lagophthalmos, and according to the National Sleep Foundation as many as one out of five of us have it -- including babies.
In fact, if you're among the 20% who have it, it's possible that your child could as well, because it appears to be hereditary. Most kids grow out of it.
Nocturnal lagophthalmos happens when the eyelids don't close enough to cover the eye, either partially or fully.
It may not be as scary as Michael Myers' mask, but it turns out sleeping with your eyes open is something to scream about to your doctor: It can signal a serious, underlying medical problem such as stroke, thyroid disease or facial nerve damage.

Remember Marty Feldman who played the servant Igor in Mel Brooks' "Young Frankenstein?" His bulging eyes were the result of a severe case of Graves' disease, a form of hyperthyroidism, or overactive thyroid. And yes, it's not easy to fully close your eyelids if you have buggy eyes.
Eyelid damage can be a reason for the failure of the lids to close. Take for example, floppy eyelid syndrome, where the lids become loose and rubbery and can easily open when you turn over at night.
Floppy eyelids are often connected to obstructive sleep apnea, a dangerous sleep disorder where the soft tissues of your throat temporarily relax, narrowing your airway. Breathing is momentarily cut off. Multiple occurrences a night are linked to an increased risk for coronary artery disease, heart attack, heart failure and stroke.

Sleeping without eyes shut can also mess up your sleep. Light stimulates the brain to wakefulness, so unless you sleep in a coffin like a vampire, keeping your peeps open all night is likely to wake you.
Nor is it good for your eyes. Your eyelids need to fully shut at night so that tears and their moisture can clean and repair your cornea. If not treated, the National Sleep Foundation says, nocturnal lagophthalmos can lead "to dry eyes, blurred vision, infection, and even permanent vision problems."

Thank goodness you're not as doomed as all those actors in slasher films. There are things you can do to help your eyes fully closed. It may be as simple as wearing an eye mask while sleeping, or even a specially made goggle that traps moisture. Using artificial tears during the day and a humidifier at night can also help with moisture loss.

Doctors sometimes recommend eyelid weights, which you wear over the outside of your upper eyelids. As creepy as it sounds, another method is to tape your eyelids shut with surgical tape.
And then there's the final option of going under the knife. No, really. In severe cases, such as facial paralysis, they do a surgery to implant a gold weight

By Sandee LaMotte, CNN
Tom's Travels
"In the last issue you got a glimpse of Buenos Aires, but Argentina is much more than its capital city."
For the meat production that the country is noted for there are many farms or ranches called “estancias”. Our group tour made a stop at one, meeting the owner and his foreman. Notice the mate cup with silver straw that the foreman is drinking from, renewing his tea with hot water added to the leaves in the bowl. We were treated to a lunch with delicious meat of our choice that we saw roasting.
 
A bus transported us to an alpine region of Argentina where we took a chair lift to the top of a mountain for photo ops of the surrounding countryside with its peaks and Alpine lakes. There is skiing of course and the further south you head you get into really remote mountainous country. We were lodged in Bariloche on a large lake and found the town’s stone architecture similar to that of downtown Flagstaff. The city is well know for its chocolate production and shops were easily found to check out this reputation. 
 
No group tours are without a few problems but ours had a major one. An active volcano near Bariloche prevented us from taking a flight to Buenos Aires so we had to take a bus across the Andes Mountains to a city safe from the ash fallout. On the way we saw towns white with ash like fallen snow and pristine lakes with ash floating near the edge as you see in the photo. Rains and time will bring the greenery and waters back to normal and also enrich the soil as nature evolves.

Save Travels!

How To Prevent Heart Disease Without
Breaking A Sweat!
Better cardiovascular health is usually boiled down to a simple philosophy: eat right and move often. But new research endorses an even easier, less strenuous method of preventing cardiovascular disease: getting in a good stretch.

For those looking to make a difference without breaking a sweat or trying out another crash diet, here’s how you can stretch your way to better heart health.

Why stretching is important
Stretching is all about placing parts of the body in positions that help lengthen or elongate the muscles and soft tissues. There are several variations, including dynamic (involving motion) and static (not involving motion). The most basic form is passive stretching, in which a position is held for a period of time with the assistance of another part of the body, another person, or a stretching apparatus.

Commonly regarded as an important precursor to aerobic exercise or as a cool down after a workout, stretching also has plenty of merits as an activity of its own. Incorporating stretching into your daily routine keeps your muscles flexible, strong, and healthy, which allows for a greater range of motion in the joints. Muscles that aren’t stretched regularly are more prone to strains, tears, and other injuries.

Stretching also relieves stress and promotes increased blood and nutrient flow throughout the body—this is where the benefits to your heart come into play.

How stretching helps the heart
Passive stretching can help decrease the risk of vascular issues, according to a new study published in The Journal of Physiology.
For this study, the researchers randomly assigned 39 men and women to either a stretching regimen or doing no stretching (control group). The stretching regimen included five sets of four leg stretches done for 45 seconds each. After the 12-week study period, the group that stretched saw a decrease in blood pressure, a reduction in arterial stiffness, and an increase in vascular function—in other words, a reduction in three risk factors for cardiovascular disease.

“This new application of stretching is especially relevant in the current pandemic period of increased confinement to our homes, where the possibility of performing beneficial training to improve and prevent heart disease, stroke, and other conditions is limited,” said Emiliano Cè, PhD, one of the study’s authors and an associate professor, Department of Biomedical Sciences for Health, University of Milan, Italy.
These findings support prior research published in the International Heart Journal, which found that just one stretching session improved vascular endothelial function and blood circulation in patients who had a recent heart attack. This suggests that stretching could be a drug-free way to preserve vascular health in patients, especially those with low mobility, even when they’re hospitalized or after surgeries.
Another study, published in the American Journal of Physiology-Heart and Circulatory Physiology, found a link between poor flexibility and arterial stiffness. Researchers measured the flexibility of over 500 adults and found that participants who could not reach to or beyond their toes in a sit-and-reach test were more likely than flexible participants to have higher systolic blood pressure.
Stretching can also be a valuable tool for relaxation, with an ability to relieve the physical symptoms of stress, which manifest as tense muscles, rapid breathing, and neck and back pain. In a review published in the Journal of Behavior Therapy and Experimental Psychiatry, study participants who engaged in stretching reported decreases in diastolic blood pressure, lower self-reported levels of muscle tension, and even lower levels of sadness.

Ways to get started
Whether you’ve been a gym regular for years or you’re dealing with low mobility, there are plenty of basic stretching movements that you can incorporate to increase your flexibility, blood flow, and energy, while lowering your risk of cardiovascular disease.

The good news is that you don’t have to stretch every single one of your muscles to reap the benefits. “The areas critical for mobility are in your lower extremities: your calves, your hamstrings, your hip flexors in the pelvis, and quadriceps in the front of the thigh,” said David Nolan, PT, DPT, clinical specialist at Mass General Sports Physical Therapy, in the Harvard Health Letter.
Here are a few tips to consider before you get your stretch on:
Be mindful: Make sure that you’re performing your stretches correctly to avoid injury. If you’re already injured, be cautious about the muscle groups you’re stretching. (Check out this handy lower extremity guide to ensure you’re using proper technique.)
Don’t bounce: Hold a stretch for 30 seconds and don’t bounce. Bouncing while stretching can slightly tear muscles which will only further tighten the muscle and decrease flexibility. Stretching should only produce mild tension, so do not force yourself into a position that causes pain.
Stretch warm muscles: It’s best to stretch after a short session of physical activity, when your muscles are warm. Stretching cold muscles can result in injury. If you’re about to do a serious workout, take a quick walk or a warm-up jog before you begin your stretching.
Set a time: Your stretching session doesn’t need to last hours. Pick a brief 10-minute window, 2 to 3 days per week.
Breathe: Avoid holding your breath. Maintain a regular breathing rhythm as you stretch.
Make your morning stretch a daily ritual or tack on a stretching session after a workout. However you choose to incorporate stretching, your body (and your heart) will thank you.

  • Connie Caponem, MDLinx

PE Early
Running Shoes
swimmer
Marie_1_2013
Dental Updates From Marie
'Dental Caries – Myths and Facts'

Dental caries is the most common chronic disease in the world. Oral disease affects 3.9 billion people worldwide. Untreated tooth decay (dental caries) impacts almost half of the world’s population, making it the most prevalent oral disease according to the Global Burden of Disease Study.
In the United States the current incidence may be less in some locations; however, dental caries continues to be a prevailing oral disease issue of concern for individuals of all ages.
This article will present an overview of dental caries and its causes, myths, and confirmed facts, followed by preventive recommendations.
OVERVIEW
Cavities/caries/tooth decay are permanently damaged areas in the hard surface of your teeth that develop into tiny openings or holes. They are caused by a combination of factors, including bacteria in your mouth, frequent snacking, sipping sugary drinks and not maintaining good oral hygiene.
If not treated, cavities get larger and affect deeper layers of teeth, potentially leading to severe toothache/pain, infection, and tooth loss. Regular dental visits and good oral hygiene habits are your best protection against cavities and tooth decay.
CAUSES
Tooth decay is a process that occurs over time; the following briefly describes how it develops.
Dental plaque forms as a clear sticky film (biofilm) that coats your teeth When sugars and starches are not cleared from your teeth, decay-causing bacteria come into contact with the sugars and starches from foods and drinks and they form an acid. Plaque that remains on your teeth can harden above or below the gum line into tarter (calculus). Tarter will make the plaque more difficult to remove and creates a shield for bacteria.  The acids in plaque, formed by the decay-causing bacteria, remove minerals in your tooth’s hard, outer layer. This acid can attack the tooth’s enamel causing it to lose minerals.
This can occur if you eat or drink often, especially foods and drinks containing sugar and starches. The repeated cycles of these “acid attacks” will cause the enamel to continue to lose minerals, becoming eroded or developing voids.
Over time, once areas of enamel are worn away, the bacteria and acid can reach the next layer of your teeth, called dentin. This layer is softer than enamel and less resistant to acid. Dentin has tiny tubes that directly communicate with the nerve of a tooth causing sensitivity. If the decay proceeds to invade the inner tooth material (pulp) that contains nerves and blood vessels, the pulp then becomes irritated and swollen. Since there is no area for expansion inside of a tooth, the pressed nerve causes pain, often severe. The discomfort can even extend outside of the tooth root to the bone.

SYMPTOMS
The signs and symptoms of cavities vary, depending on their extent and location. For early tooth decay, there are usually no symptoms. However, as the decay advances, in can produce toothache (tooth pain) or tooth sensitivity to sweets, hot, or cold. Should the tooth become infected, an abscess can form that can cause pain, facial swelling, fever, and even further complications.
 
Now that you have the basic information regarding dental caries, reviewing the following myths and facts may, hopefully, expand your knowledge further.
MYTHS AND FACTS ABOUT DENTAL CARIES/TOOTH DECAY
1.If my teeth don’t hurt, they’re fine.
MYTH. Not necessarily – tooth decay may be present, but it has not affected the nerve yet. Lack of pain does not mean a lack of a problem. For this reason, regular check-ups are of the essence so the presence of tooth decay, or any oral problem, can be identified and treated before causing discomfort and the need for costly treatment.
2. If my teeth are sensitive, I must have cavities.
MYTH. While some cavities can cause sensitivity, it can also be a result of other factors such as     receding gum tissue or even a sinus infection.       
3.Chips and cracks in teeth lead to decay.
FACT. Cracks and chips create an environment for bacteria where a toothbrush cannot reach. Your oral care provider can recommend or prescribe an antibacterial mouth rinse or fluoride rinses to clean such areas.
 
4.Sugar is the only thing that causes cavities.
MYTH, but it is almost a Fact.
“The truth is, acid produced by bacteria in your mouth is the cause of cavities,” says Kimberly A. Harms, D.D.S., an American Dental Association spokeswoman. The sugars/carbs in foods like bread, fruits, etc. act with bacteria in your mouth to form acids that erode away healthy minerals in your teeth if you do not regularly brush/floss/rinse the plaque that forms on teeth.
5.Sugar-free drinks do not cause cavities.
MYTH. The misconception that sugar-free soda/cola will not damage teeth has been popular for decades. Despite containing less or no sugar, sugar-free drinks are often filled with phosphoric, citric, or tartaric acid and that is the problem. While most people know that drinking sugary drinks can lead to tooth decay, fewer are aware that dental erosion that occurs when teeth are exposed to acid is the main cause of cavities. Also, not only can acidic drinks lead to tooth decay, so can acidic foods such as grains, citruses, tomatoes, coffee, alcohol, processed foods, etc. All acidic foods are linked to the formation of tooth decay.
6.Cavitiies are contagious.
FACT. Studies have shown that babies are not born with the bacteria that cause cavities but are infected most often by their parents or caregivers (often referred to as “vertical transmission”). This happens when a baby is kissed, milk or other foods are tested for temperature, and pacifiers are “cleaned” in the parent’s mouth.
7. I get cavities because I have soft or weak enamel.
MYTH. As has been stated, it is the acid produced by bacteria that is the cause of cavities. This has been scientifically proven. When the pH (see below for definition) in the mouth drops below 5.5, demineralization of enamel takes place. So, if you are prone to cavities, it is not because your enamel is, by default, softer. It is that you have risk factors that are keeping your mouth too acidic.
(pH is a measure of the acidity or alkalinity of a solution. The pH scale usually ranges from 0 to 14. Solutions with a pH less than 7 are acidic, while those with a pH greater than 7 are basic or alkaline. A pH level of 7.0 is defined as “neutral.”)
8. Untreated cavities lead to a root canal treatment.
FACT. If a tooth has decay that is untreated and it gets to the nerve, causing the nerve to die, you will be faced with the choice to save or lose a tooth. This choice is not appealing. Avoid this situation by getting routine dental care when such issues can be treated at an earlier state.
9.Children’s baby, or primary teeth, cannot get cavities.
MYTH. Any enamel, especially in babies and young children is prone to decay. To protect their teeth, limit sugary drinks and snacks and help them develop a healthy oral hygiene regimen at a young age. It is advisable that brushing should be started by parents immediately after the first teeth appear.
10.Children get more cavities than adults.
MYTH. Because of the addition of fluoride to tap water, decay in school-age children has been reduced by half in the last 20 years. However, cavities in adults are on the rise because of medications and other factors that cause xerostomia (dry mouth), reducing saliva which protects teeth.
11. Chewing or placing an aspirin tablet next to a tooth will relieve a toothache.
MYTH. You need to swallow the aspirin to ease your pain. Since aspirin is acidic, if placed next to a tooth, it could burn the gingival tissue and cause a serious burn or abscess.
12. Brushing and flossing are sufficient to fight decay.
Myth. Brushing and flossing alone do not kill the bacteria that are the real cause of decay. Dental caries is a complex biofilm infection and currently there are 23 strains of bacteria in biofilms that produce cavity-causing acids.
Prevention is the key and brushing and flossing (or using a interdental cleaner) are certainly an important part of the “Prevention Package.” Visit your dentist regularly – get professional teeth cleanings and oral exams.  If one has a high risk of developing cavities, an antibacterial mouth rinse with fluoride or fluoride treatments applied in custom trays or a rinse may be recommended.
Furthermore, avoid frequent snacking and sipping. If you drink and snack throughout the day, your teeth are under constant attack. Drink some fluoridated tap water since, by drinking only non-fluoridated bottled water, you will miss the fluoride benefits. Eat tooth-healthy foods; avoid foods that get stuck in the grooves and pits of your teeth for long periods, or brush soon after eating them. However, fresh fruits and vegetables increase saliva flow and help wash away food particles.
Follow preventive practices daily to maintain good oral health and a happy smile.

Here’s to your good health!

Marie C. Jacobs, D.D.S.
Professor Emerita Loyola University Chicago
Mouth Breathing Might Be Ruining Your Sleep.
Here's How To Fix It. . . .
Living with a plugged nose isn't fun, but James Nestor was ready. Plus, it was for science.

While researching his recent book, "Breath: The New Science of a Lost Art," Nestor let Stanford University scientists block his nostrils with silicone and surgical tape to measure the impacts of breathing through his mouth for 10 days.

"We knew it wasn't going to be good, because there's a very firm scientific foundation showing all the deleterious effects of mouth breathing, from periodontal disease to metabolic disorders," Nestor said. The surprise was just how quickly the experiment affected him.
Nestor's blood pressure rose 13 points, edging the writer into stage one hypertension. Measurements of heart rate variability showed his body was in a state of stress. His pulse went up, and he stumbled around in a mental fog.

He also snored for hours each night, developing obstructive sleep apnea. His blood oxygen levels dropped.
"We had no idea it was going to be that bad," Nestor said. "The snoring and sleep apnea was so dramatic, and it came on so quickly, that everyone was pretty floored."
What Nestor learned, aside from the hazards of being a research subject, was that mouth breathing can ruin a good night's sleep.

Insights By Steve
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50 Things Over 50 We Still Love
Every Day
Yes, the world has changed radically over the past five decades. Many of America’s favorites today would have been unimaginable in 1970. But have you considered how much of our cultural landscape was already with us — and already beloved — 50 or more years ago? We have, and we decided to salute these super-survivors.

Around The House
Electric drip coffee maker, 1954 — But Mr. Coffee brought them to homes big-time in 1972.
Mr. Potato Head, 1952 — Toy Story has ensured this fave’s longevity.
Color TV, 1950 — And adopted by the three networks in 1965.
Tupperware, 1946 — The parties were epically important to its success.
Ice cooler, 1953 — A true landmark in global cooling.
Microwave, 1945 — Beeped into homes in the late ’60s. It never left.
Handheld hair dryer, 1920s — The wet head — thankfully — remains dead.
Lego toys, 1949 — From the Danish leg godt, which means “play well.”
UPS, 1953 — Until drones take over, we’ll await the brown truck — nearly every day

Money
American Express, 1958 — The first boost to our love affair with debt.
Warren Buffett, 1930 — A $10,000 investment in him in 1962 is worth $298 million now.

Getting around
10-Speed Bicycle, 1960 — A paradigm shift from the 3-speed.
Ford Mustang, 1964 — The everyman muscle car persists!
Skateboard, 1959 — You’ve made it when the Olympics come calling (summer 2020, Tokyo).
Harley-Davidson, 1903 — From Brando to ... Leno?

Health & Wellness
Sunscreen, 1935 — Slather up; ward off deadly rays.
ChapStick, 1880 — Pucker up!
The pill, 1960 — There’s no sexual revolution without it!

Entertainment
Tony Bennett, 1926 — At 93, no plans to retire.
Stevie Wonder, 1950 — Debut album at age 12.
The Beatles, 1962 — Life without them? Impossible. See the film Yesterday!
Motown songs, 1960s — “My Girl,” “I’m Losing You” and many tunes turned out by the Temptations and other now-revered acts are Detroit’s longest-lasting vehicles.
Jeopardy! 1964 — Nearly 10 million people watch every night.
Star Trek, 1966 — In 2020 the Enterprise is back, on CBS’ Star Trek: Picard.
Spider-Man, 1962 — Big on the web! 
Margaret Atwood, 1939 — Her first novel, The Edible Woman, 1969, presaged the Handmaid saga.  
Green Eggs and Ham, 1960 — Beloved by boomers and their grandkids.
To Kill a Mockingbird, 1960 — We still buy a million copies a year.
Smiley face, 1963
James Bond, 1962 — Sean Connery was the first 007; Daniel Craig (the sixth) returns in No Time to Die, out this April. 
Clint Eastwood, 1930 — Good, bad, but never really ugly, right?

Style
Birkenstocks, 1964 — So ugly, so comfortable; 25 million are sold each year.
Miniskirt, early 1960s — The stock market is said to rise when hemlines do.
Spandex, 1959 — Stretches more than 500 percent.
Chuck Taylor high-tops, 1932 — Perennially cool — think James Dean, the Ramones and Madonna.
Tie-dye, 1960s
Bikini, 1946 — Named after an atom-bomb test site. Still detonating on beaches worldwide.
Ray-Bans — Tom Cruise and other stars have helped bring back retro-cool Wayfarers, 1952, and Aviators, 1937

Food & Beverage
M&Ms, 1941 — Still the most popular candy on earth.
Gatorade, 1965 — Led the way to the sports-drink boom.
Subway (the store), 1965 — Currently sells 5,300 subs a minute!  
Frozen pizza, 1957 — In 2018, 198 million people indulged!
Big Mac, 1968 — Second in popularity only to — yes — french fries.
Hershey’s Kisses, 1907 — Valentine’s Day mainstays.
Cheerios, 1941 — Those oat rings remain the top-selling cereal.
Pop-Tarts, 1964 — Named for Andy Warhol’s pop art movement.
Cheetos, 1948 — The orange snack was a World War II invention.
Kraft Mac & Cheese, 1937 — About 1 million boxes are sold per day.

  • by Peter Moore, AARP





Autumn Recipe:
Vegetarian Chili with
Grains and Beans
By Kate Merker and Taylor Murray
This slow cooker chili is as filling as its meatier mainstay because of its hearty helping of high-protein wheat berries and kidney beans.

Ingredients

1 (28-ounce) can fire-roasted crushed tomatoes
1 (14.5-ounce) can petite-diced tomatoes
1 tbsp. chili powder
2 tsp. ground cumin
1 tsp. ground coriander
3 cloves garlic, pressed
1 onion, chopped
1 large carrot, chopped
1 large poblano pepper, chopped
3/4 c. wheat berries
Kosher salt and freshly ground black pepper
1 (15.5-ounce) can black beans, rinsed
1 (15.5-ounce) can kidney beans, rinsed
Sour cream, grated Cheddar cheese, sliced scallions, fresh cilantro, and lime wedges, for serving

Directions

  1. Combine crushed tomatoes, diced tomatoes, chili powder, cumin, coriander, garlic, onion, carrot, poblano, wheat berries, and 3/4 cup water in a 5- to 6-quart slow cooker. Season with salt and pepper. Cook, covered, until wheat berries are cooked but still chewy, 7 to 8 hours on low or 5 to 6 hours on high.
  2. Stir in both beans and cook until warmed through, 8 to 10 minutes. Serve with sour cream, Cheddar, scallions, cilantro, and lime wedges alongside.
And Your Pandemic Moment of Zen. . . . .
Paradise Valley Medical Clnic
Douglas M. Lakin , MD
9977 N 90th Street, Suite 180 Scottsdale, AZ 85258
480.614.5800 (Ph) 480.614.6322 (Fax)