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Happy Mother's Day and May and Indy 500 Month!
I was so very blessed last Sunday to have 4 of my children (missed you Easton and your 2 Frenchies!) and Bruce and I in a park with a terrific photographer Liz Kaye. I love enjoying God's beauty, family, and taking pictures, so it was a perfect Mother's Day for me - thank your family and Liz! Liz has such great talent and specializes in dog and puppy photography, and families along with them! She is always looking for dogs and puppies to photograph (and with the owners permission submits them to calendar, magazine, and greeting card companies) and owners/families if desired. If you, too, are interested in having your special pet photographed, contact Liz at 317-357-5785,
http://www.lizkaye.com/. We all had a wonderful afternoon in the park together!
I want to thank all my so very special patients for giving me the honor of caring for you and learning and sharing from you! I will summarize the frequent problem of constipation and "A Weekend to Remember" for marriage, and begin to share insights from 2 good books on parenting boys and girls. I love to learn and read, and await my patient Shelly's tips on a gluten free diet to share with you soon (she feels so much better and has lost 15# in not quite 2 months). My thumb is still bothering me with swelling and pain and a splint, so I am sorry my blogs are a little late (I know it will heal in time, and now I know what a broken bone is like)!
Lab tip from my patient Andrea (for people with a large deductible or no insurance)- LabCorp at 75th and Shadeland has many less expensive/cheap lab tests available even without an order, like a 14 panel test including blood sugar, cholesterol, liver enzymes for $27 plus a $10 draw fee (needs to be paid at the time of draw). The website is
http://www.labcorp.com/, and phone # is 317-577-5820.
Constipation
Constipation refers to a change in bowel habits - stools may be too hard or too small, difficult to pass or infrequent (less than 3 times/week), and people may notice a frequent need to strain and a sense bowels are not completely empty. The prevalence of constipation in the U.S. varies between 2 – 27%, and is more common in women, people with less physical activity, and those over 60 (with 26% of men and 34% of women reporting constipation). I will first discuss constipation in adults and then in children.
Adults
Many factors can contribute to constipation, although in most people no single cause can be found. The most common contributing cause is poor dietary fiber and water and magnesium intake and lack of physical activity. Other causes can be systemic disorders (such as hypothyroidism and diabetes), neurologic or obstructive intestinal disease, irritable bowel syndrome, or commonly as a side effect of medicines (especially pain medicines). You can usually treat constipation at home, but come to see me if the problem is new and lasts longer than 2-3 weeks, is severe, or is associated with concerning things such as blood on the toilet paper, weight loss, fevers, or weakness.
Treatment includes changing some behaviors, eating foods high in fiber (lots of healthy vegetables, fruits, and beans), taking magnesium, drinking plenty of water, and natural supplements or laxatives/enemas if needed.
Behavior changes – The bowels are most active following meals. This is the time when stools pass more readily, so pay close attention and go to the bathroom when you get the signal (and a small amount like a cup of coffee can be helpful). Ignoring your body’s signals to have a bowel movement can make the signals weaker over time.
Increase fiber (at least 25-30 grams/day) and water (at least ½ of your body weight in ounces/day) – Eating at least 5-10 servings of healthy fruits and vegetables/day and legumes/beans is very helpful for constipation and required for the best health. Often grains, especially wheat, are not the best because gluten intolerance is an alarmingly increasing problem and grains can interfere with your body’s magnesium absorption.
Magnesium as a nutrient not a laxative (anyone with kidney disease should not take magnesium supplements without consulting your kidney specialist) – Adequate magnesium levels in the body cause water to be drawn into the colon, where it softens the stool for easy passage, and magnesium acts as a natural stimulant on bowel muscles (magnesium is beneficial to the body in many other ways for energy production, proper insulin use, heart rhythm and blood pressure, and overall feeling of calm). Magnesium is in high concentration in green plants, and are best eaten properly cooked (not overcooked!) or raw. Also, if we were eating our meats from animals grazing on open pastures of grasses and herbage, these meats would have substantial amounts of magnesium.
For adults to determine your effective magnesium dose, start with 150-200mg after dinner, and can increase it by 150-200mg every 2-3 days until your stools are regular (most people find their effective dose between 400-1200mg/day). If you start having loose stools, then gradually decrease your dose. Remember that during stress your body uses up more magnesium, so you may require more during those times. Also, you may need more magnesium when eating dairy foods from cow milk (contains the sticky protein casein).
Magnesium aspirate (the one we carry at our office) or citrate in capsular forms are the most absorbable forms of magnesium, and very good when in combination with vitamin B6 in a well absorbed multivitamin in capsular form (like our Orthomolecular Alpha Base) or B complex vitamin. The best most well absorbed vitamins are almost always in capsular forms, and you need also to check the contents (see “How to Pick Out Vitamins and Supplements” on the 2nd page of my “For Your Health” article accessed under “Resources” on our home page). Be very wary of drugstore or discount store vitamins and supplements which are often very poorly absorbed and poor quality, and get your vitamins and supplements from a trusted informed place like our office or quality health food store (and still check the contents or bring in at your next visit with me to check).
Aloe Lite (supplement at our office) – take one daily (and can take up to two) containing 150mg/capsule aloe vera (anti-inflammatory for the digestive tract helping constipation and even diarrhea/irritable bowel), slippery elm (soothes digestive tract mucosa), and stone root (can help shrink and decrease inflammation of hemorrhoids)
Laxatives – You usually will not need any of these by following the above, but if you do, here are the categories.
Bulk forming Laxatives – Psyllium (Metamucil, Perdiem), Methycellulose (Citrucel), Calcium Polycarbophil (FibeCon, Fiber-Lax), Wheat Dextrin (Benefiber) – Increase these slowly to prevent gas and bloating, and always take with at least 16 ounces of water.
Hyperosmolar Laxatives – Polyethylene Glycol(MiriLax, GlycoLax), Lactulose prescription generic medicine and Sorbitol (these produce more gas and bloating than polyethylene glycol).
Saline Laxatives – these act similar to the hyperosmolar laxatives and include Milk of Magnesia and Evac-Q-Mag.
Stimulant Laxatives – include senna (Ex-Lax, Senokot, Flether’s Castoria) and bisacodyl (Correctol, Dulcolax) – overuse can cause side effects such as low potassium
Stool softeners – less side effects but less effective than laxatives – docusate (Colace)
Enemas – sodium phoasphate/biphosphate (Fleet) can be used and work quickly but are not recommended for people with kidney or heart problems, and hydrogen peroxide enemas should be avoided due to extreme colon lining irritation
Others – mineral oil (prolonged use can decrease absorption of nutrients or hurt the lungs if vomited), a prescription medicine Amitiza, or other natural products
Children
Complaints of constipation from children should not be ignored. If the opportunity for early intervention is missed, complications can quickly occur such as worsening constipation, stool withholding and fecal soiling, anal fissures, and even fecal impaction. The times when constipation are most likely to occur include: introduction of solid foods or cow’s milk/dairy, toilet training, and school entry.
Transition to solid diet – Ensure adequate fiber in fruits and vegetables (about 20grams/day in toddlers and young children) and adequate water (about 1 ounce per pound body weight in toddlers and children). Limit cow’s milk to less than 24 ounces/day.
Toilet training – Ensure the potty seat provides appropriate foot support and leverage for elimination, and that your child’s diet has adequate fiber and water and not too much cow’s milk/dairy. Once stool withholding behavior has begun, it can only be reversed by making the stools soft and passage pain-free. If your child just does not like having a bowel movement on a potty after your best encouragement and instruction, you may need to use a glycerin small child suppository to encourage them. (I had to do this with one of my children, and it only took one suppository to then encourage that child to regularly use the potty!)
School entry – Some children do not want to have a stool at school or do not have enough time, so they withhold their stools. Make sure to occasionally ask about their bowel movements, especially in young school age children. The best time to have a bowel movement as discussed above is usually following meals and paying attention to your body signals.
Treatment
In infants less than 1 year – Addition of indigestible osmotically active carbohydrates to the formula – increasing the dose as needed to induce a daily bowel movement. This includes sorbitol-containing juices or purees (for babies who have started solids) – apple, prune or pear. Barley cereal may e substituted for rice cereal, and soy formulas may be tried. Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer can be used occasionally if there is very hard stool in the rectum (but not used frequently).
Older children – Ensure adequate fiber and water and you may need to eliminate cow’s milk/dairy. Children unwilling to consume adequate dietary fiber may need daily fiber supplement (as described under adults, but 20 grams/day for early childhood and 30 grams/day for adolescent girls and 40 for boys). An occasional does of laxative may be needed, or an enema if a child has not had a bowel movement for several days and cannot pass a stool.
Eric's Fitness Tips
By:Eric Walden
Older Adults Continued - pictures to come soon
In February we started a series for older adults and I want to continue that series for a little while longer. I want to go over a couple of exercise routines for bad or achy knees. I can’t tell you how many people I talk to with bad knees. It doesn’t matter the age or gender. It seems that everyone has achy joints. So I want give you some solid solutions to working around and strengthening the knee joints.
When addressing a client with knee problems I always ask if they have had any surgeries. Most people tell me no, but they follow it up with my doctor tells me it is going to be replaced. I say okay what have you done since then to strengthen the muscles around the knee. The answer is almost always nothing. Sometimes the answer is I have tried different stuff but my knees just ache so I quit. I honestly love both of these answers, because this opens the door for me to be able to try a variety of different exercise routines with them. When a client has tried but given up on exercises I usually find that they only tried it once or twice. Now there are always exceptions. Another reason I love working with clients with “problems” is because I enjoy figuring out how to help with work around the pain. By “working around” the pain I mean working different ranges of motion (ROM). Most leg machines have a ROM adjustment. Typically this adjustment isn’t shown in an orientation; mainly it gets very confusing to the new member. But look for one. I’ll give some examples here and hopefully paint a good picture for you. Plus I will post a couple of pictures as well to help. Not all machines are the same, so there will be some varying adjustments depending on the type of machine that is being used.
Leg Extension Machine:
Toning Strengthening
Sets: 3 3
Reps: 12-15 6-8 add more weight
Adjustments:
The pad should be just above the tongue of your shoe. A ROM adjustment would be that you feet are starting out underneath you. This can usually be adjusted to start out farther so your feet don’t go behind you so much in the down position. Typically the user straightens their legs straight out raising the pad up. The top part can sometimes be adjusted as well to stop the user from going all the way up.
I will start a client off with the full ROM and adjust it to a shorter ROM depending on how they are feeling (ie. Pain level). I let the client tell me how they are feeling then I adjust the ROM to keep them out of a ROM of pain. For example say the client bends their legs and their feet are underneath them, but that position hurts. I will adjust the ROM so the legs don’t bend so far back in the down position. Then I will have them do a few more reps to see if this ROM hurts. I will do this until I find a pain free ROM. The same holds true for the top position. If pain is present at the top I adjust so they client doesn’t raise
the pad to the top position.
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Leg Curl Machine: seated or lying
Toning Strengthening
Sets: 3 3
Reps: 12-15 6-8 add more weight
Adjustments:
The same holds true here as well as the leg extension. It doesn’t matter if it the seated or lying machine. If at any point of a full ROM there is pain adjust the machine so there is none. On this machine it is usually the start position that hurts most people. This machine tends to “hyperextend” the knee when starting. I personally love the stretch it gives my tendons when I start this machine. I don’t leave my legs there more than 10 seconds though. Typically you can adjust this so you start with your knees slightly bent. I personally prefer the lying leg curl machine. I feel like my hamstrings getting a workout. Plus I can do single leg sets easier from this position as well.
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Leg Press:
Toning Strengthening
Sets: 3 3
Reps: 12-15 6-8 add more weight
Adjustments:
This one is the easiest to adjust. The ideal starting point for a leg press is the knees bent to 90 degrees. Now some people can’t get down to 90 degrees because of how big their bellies are or because of bad knees. Go down as far as possible to start. Use a full ROM for a few reps and see how your knees feel. If there is pain stop above or below where the pain is located.
Lunge:
Toning Strengthening
Sets: 3 3
Reps: 12-15 6-8 add more weight- ie. dumbbells
Adjustments:
You don’t have to go all the way down for this exercise to be effective. I like to put first timers or my “knee” pain clients in a squat rack with the bar set at waist level. The bar is to hold onto while performing the lunge. This is an aide to the lunge. As you go down hold onto the bar and if the movement becomes difficult use your arms to help pull you up. I have a current client that needs a ton of help doing this exercise but it is so effective in strengthening the quadriceps muscles. It has helped improve her stair climbing ability and walking distance.
Adductor/Abductor:
Toning Strengthening
Sets: 3 3
Reps: 12-15 6-8 add more weight
Adjustments:
There aren’t any adjustments that will help the knees are these two exercises. They are however two great exercises for strengthening the out and inner legs. Any exercise that helps with strengthening of the upper leg is going to be key in keeping the knees from aching.
This routine is a very simple straight forward leg routine. If you get anything out of this article I hope it is that you can still do a variety of exercises and work around the pain.
As summer gets closer I know a lot of people will be hitting the walking trails and getting out more. Remember to keep lifting weights even through the summer. You don’t want to lose what you have gained in the winter months (muscle that is). I currently have some openings for anyone who would want to do some personal training as well. This is a good time as any to use a trainer to help get you going on the right foot. Check out my website for more information and my email. http://www.waldospersonaltraining.com/
Family and Faith
"A Weekend to Remember", from Family Life - this June 4-6th downtown at the Indianapolis Marriott-sign up at
www.familylife.com to spend needed time and continuing education for your marriage! Below is my summary from the seminar last June 2009...
Family and Faith “A Weekend to Remember” Marriage Retreat (
http://www.familylife.com/) This is a marriage, life, and family changing terrific Christian marriage retreat. My husband Bruce and I so learned, discovered, enjoyed, and were renewed by attending this conference! It is tremendous and life/marriage changing to take the time to focus on each other and learn to love your spouse better the way they want to be loved.
I strongly encourage you to spend the time and effort on each your marriage and family legacy to attend this or a similar marriage enrichment conference. Your spouse is your gift from God!
The topics covered were:
Why Marriages Fail - due to difficult adjustments (differing backgrounds, motivations, expectations), culture's pattern of 50/50 (vs God's encouraging oneness, giving 100%, looking at self), inevitable difficulties (need plan so will not drive apart), extramarital "affairs" (work, kids, activities/business, materialism, fantasy/porn, infidelity, isolation), and selfishness
Can We Talk – helping communication w a project - how can we understand our spouse (and NOT how we can get them to do what we want), LISTEN/repeat back/ask more questions
Unlocking the Mystery of Marriage - Our spouse is our gift from God
God's purpose for oneness -- to mirror God's image, mutually complete one another, multiply a Godly legacy with your children, keep away Satan (no secrets, work on yourself /struggles and be willing to hear feedback about yourself, be more dependent upon God)
From How to Wow - God's plan for oneness and a project (writing each other a love letter) -- Leave (establish independence from parents), Cleave (establish commitment to one another), Become one flesh (establish intimacy with one another) - this can be very difficult due to our differences, weaknesses, and self-centeredness
-we need to celebrate differences and help in each other's weaknesses
What Every Marriage Needs - God's power for oneness -- establish a relationship with God, experience an ongoing relationship with God together (read bible, pray together and individually, church home, time w other Christians/small group)
We Fight Too – with a project -- Conflict (and opportunity to know each other better) and to avoid conflict is to avoid reality
--resolving conflict requires loving confrontation (slow down and check your role, motives and heart, and choose your words carefully)
--resolving conflict requires choosing forgiveness (admit you are wrong, humbly seek forgiveness, release your spouse free from seeking revenge, build trust by consistent behavior over time)
--we minimize conflict when we choose to actively bless one another in marriage - refrain your tongue from speaking evil, turn away fro evil, do good, bee a peacemaker (anger shows that I care more about how we look than God) - I love you and your are not my enemy!
Marriage After Dark (with a project) - sex was created by God and designed for our good (the freedom to enjoy each other's body), sex is a thermometer that can measure your individual well-being, sex can be enhanced by understanding the differences between man and woman, and a great sex life is built on - Companionship (communication, tenderness, spending time together), Commitment (faithfulness, respect, forgiveness), Passion (planning and creativity), and Spiritual Intimacy (prayer and the Bible)
Woman to Woman - Priorities (#1 grow in her relationship w God, #2 respect and support her husband, #3 teach/train her children w wisdom from the Bible, #4 everything else ordered after the 1st 3!), God's design (equals w different roles/responsibilities/purposes - husband as leader and each other complete through marriage and mutual submission/selflessness), Respect and support her husband (unconditional respect which empowers her husband, thankfulness, praise, listening, sexuality, encouraging words/attitude/actions, never criticize husband in public or in front of children), Depend on God
Man to Man - Follow and obey Christ and his leader, Role as leader in marriage - sacrificially loving his wife (cherishes, trustworthy, listening, helping, praying, putting her needs ahead of his own, nourishes her gifts/dreams/love/romance), courageously leading his wife (finances, 1st taking care if wife and children, protecting his family emotionally/spiritually/physically), Responsibility as father (each child a unique gift from God, loves and cares willingly/eagerly/consistently/not domineering, spends time listening/hugging/things they enjoy/praying, leads by example and with God/loves their mother/teaches biblical wisdom)
How Marriages Thrive for Oneness in Marriage and a revolutionary relationship
-the habit of extravagant love is a choice and leads to genuine intimacy (Exclusive- one person having your heart for a lifetime, Expressed by repeating often through words and actions, Extraordinary-placing spouse's needs above your own)
-the habit of generous forgiveness leads to true security (with humility and without bitterness)
-the habit of enthusiastic encouragement leads to unity and team together for life (believe in and motivate your spouse, openly affirm/praise, maintain positive attitude, avoid critical words)
Leaving a Legacy - for our the next generations
-by doing the constant work of strengthening our marriage and family and relationship with God, and always looking to serve God and others
Lisa's things to remember from the conference
-work hard to love God and Bruce - to mirror God and complete each other
-work hard to avoid "extramarital affairs" such as work or business or selfishness
-celebrate each other's differences and help each other in our weaknesses
-take the time to raise Godly children - teach, train, talk
Lisa's top 3 priorities from the conference experience
-be my husband Bruce's cheerleader
-listen, repeat back, ask more questions
-work together to avoid "extramarital affairs" for each other and our
Parenting
I read 4 great parenting books while on my spring break vacation. Over the next several blogs, I will summarize parts of "MOM'S Everything Book for Daughter's" by Becky Freeman, and "Bringing up Boys" by James Dobson.
Daughters: Build your mother-daughter connections by making her feel loved by,
1. Give her the gift of your presence - listen with focused attention, sit and slow down, look her in the eyes, touch her in motherly ways (stroke her hair, rub her arm, hug her).
2. Speak to her with respect and kindness
3. Encourage her efforts with enthusiast.
4. Seek first to understand your daughter's point of view.
5 Answer her honest questions with your honest answers.
6. Say yes whenever you possibly can (reserve no for when necessary).
7. Ask her opinion.
8. Allow your daughter to feel any feelings she may have.
9. Let her cry, and don't be afraid to cry with her (you could have or make a family teddy bear that is passed to the person most in need of some extra love and cuddling on a particularly trying day).
Ideas to do together - plan a time to look over baby or girlhood pictures, watch a great mom-daughter movie (like Princess Diaries, Mary Poppins, Father of the Bride, Singing in the Rain, etc.-get the book for a long great list and many great ideas), read Proverbs 31:10-31 together (about the virtuous woman)
Sons
The hormone testosterone in largely responsible for maleness. It shows up in the 6-7 week embryo and begins transforming them into boys (it is a hormonal bath that changes the make-up and even color of the brain).
Boys are men in training, and often value change, risk, speculation, and adventure, and need to be shaped, molded, and "civilized". Watch out for wounded spirits in your boys from other children being mean/taunting, schools, and society (closely monitor any TV watched and computers). Be available and listen without judging or belittling.
A good summary of raising healthy boys in our shock-wave wounded world is from columnist Kathleen Parker... "We need to be reasonable, smart, and fully awake. Reduce boys' exposure to violence, be there when they return from school, help them with homework, ask them about their day, let them cry if need be, support them when they're down, help them to see options, teach them to handle guns safely if you have them, reward good behavior, provide meaningful consequences for unacceptable behavior, make reasonable demands, express moral expectations, talk to their teachers, and hug those boys every chance you get. Don't ask them to be men when they're just little boys, but show them how to be real men by demonstrating the thing we as a society seem to have lost: self-control. It's the greatest gift, and it isn't even rocket science. It's just good parenting."
Next blog I will write Dr. Dobson's comments about Father and sons and Mother and son's relationships. He starts out with the statement that we as parents need to have our sons (and daughters) see a sermon, NOT hear a sermon... see us doing what is right even though it is inconvenient or difficult!
Faith
I my Bible study the past two weeks, a couple things really stood out to me:
1. As the 5th pledge of believing God from Beth Moore covers, I need to remember and believe that God's word is alive and active in me (and in YOU!) and when I speak it out loud it is even more alive and powerful! Proverbs 18:21 "The tongue has the power of life and death, and those who love it will eat its fruit." For reasons ultimately known to God alone, He has ordained that spoken words carry a power, authority, and effectiveness that exceed words we simply think. Therefore, I (and you) need to speak out loud more and daily of God's words, promises, our prayers, and for satan to stay away. When reading the Bible, make sure to read out loud at least some of what you read.
2. Do not let life's disappointments hinder our pursuit of God and reaching out to others in love. Remember that the Holy Spirit is always in us with God's all surpassing power, and putting our favorite Bible verses on 3x5 cards and memorizing them is great to do (I often memorize while jogging or exercising). Then we have God's words set in our hearts and ready to be remembered, utilized, and spoken - having our shield of faith and armor of God, and remember the power of praying God's words and promises in your prayers...
Psalm 91:14-15 "Because I have set my love upon You, You will deliver me. You will set me on high, because I have known Your name. I will call upon You, and You will answer me. You will be with me in trouble; You will deliver me and honor me."
Psalm 37:5 "Delight yourself also in Me, your Lord, and I will give you the desires of your heart."
Prayer - God forgive me that I so often allow disappointments in life deter me from moving toward You. Help me put everything I am and have in your hands - with nothing held back!
Hugs and prayers for you to be filled to overflowing with the fruit of His Spirit! Gal.5:22
Dr. Lisa