Wednesday, December 28, 2011

The last show of 2011... Recap the 20 best HCG diet tips 12/28 by The hCG Diet Coach | Blog Talk Radio

The last show of 2011... Recap the 20 best HCG diet tips 12/28 by The hCG Diet Coach | Blog Talk Radio

Call my office Lombard (630) 627-3700 to set up an appointment or email me at

Sunday, December 25, 2011

What is the best delivery system for Bioidentical Hormones?

What’s the best delivery system for bioidenticals?

Generally, I try and put the hormones directly into the bloodstream without having to go through the stomach, intestine, and liver first. This is more physiologic (like normal human physiology) and does not cause adverse effects on clotting factors thus avoiding increasing one’s risk of stroke, heart attack, and venous blood clots.

There are five ways to do that:
1. Subdermal -- under the skin as with Pellets
2. Trans-dermal (through the skin as with patches, gels, or creams),
3. Vaginal suppositories or gel
4. Sublingual (under the tongue), or
5. Intramuscular injection (as with testosterone cypionate which is not quite bioidentical).

I prescribe compounded transdermal creams of female and male hormones quite frequently. With creams, it’s easy to change dosing and can be tailored just for you. It allows for more physiologic cycling if desired. However, it is more inconvenient and more costly, and the benefits might not exceed the costs for some people.

I use highly experienced compounding pharmacies who have excellent reputations amongst doctors like myself to make up these prescriptions for you.

Oral Prometrium or other progestin must be taken about 2 weeks a month or six days a week if you have your uterus still.

I hardly use sublinguals. They have to be dosed twice a day and allowed to dissolve under the tongue.

I’m using injectable hormones only for males, and it is called testosterone cypionate. I recommend injecting it once a week to reduce the peaks and valleys in blood levels.

I do not prescribe HGH (human growth hormone) in my practice at this time. It’s very expensive and its use is controversial.

For an excellent article on bioidentical hormones out of Harvard, go to

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Sunday, November 27, 2011

Can't Sleep? Why Not?

The management of menopause today is a confusing and borders on negligence. As a result, women’s quality of life and longevity are being unnecessarily compromised. While health care professionals continue to debate about when menopause begins and ends, whether menopause should or should not be treated, and if so, with what, for how long, and by what delivery method, millions of women suffer needlessly and billions of health care dollars are pointlessly expended.

The current approach to managing menopause is either to do nothing or to simply treat its symptoms but not its cause. This approach is wrong, shortsighted, destructive and costly to women.

It is wrong for a number of reasons. One, this approach views menopause as merely a harmless transition out of a woman’s childbearing years during which she must cope with a number of temporary, bothersome symptoms, such as hot flashes, night sweats, mood changes, loss of libido, INSOMNIA, weight gain around our midsection, heart disease, bone loss leading to osteoporosis, forgetfulness leading to dementia.

Failure to treat menopause correctly is unacceptable to me! It is not as if menopause affects only a small fraction of the population. It affects all women who live to middle age — that’s 50% of the population, 100% of the time! Furthermore, the cause of menopause is absolutely known, as are its effects.

The medical profession is woefully misinformed about the long-term effects of menopause on a woman’s quality of life and well being. We didn’t used to live long enough for the ravages of menopause to be apparent!

In other words, we are in this mess due to misinformation, misunderstanding, and a lack of financial incentive to change it. Actually, if you ask me, for some, there is a tremendous disincentive to change it. The drug companies and hospital facilities make billions of dollars thanks to the mistreatment of menopause.

I practice what I preach. I treat menopause as the permanent loss of a hormone system. By treating the cause of menopause, I successfully help literally thousands of women slow down their aging process, defend against degenerative diseases, lose weight, have more energy, and generally feel better, while at the same time effectively treat such common menopause problems as:

• Hot flashes
• Sleep disruption
• Heart palpitations
• Night sweats
• Vaginal dryness
• Low sex drive and difficulty achieving orgasms.

By treating the cause of menopause, I have also been able to:

• Reduce cholesterol levels without cholesterol lowering medications
• Normalize blood pressure without blood pressure lowering medications
• Remedy sleep disorders without sleeping pills
• Improve blood sugar levels in women with diabetes without drugs or insulin
• Increase bone density without using anti-resorptive drugs.

The results are truly amazing!

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Friday, November 4, 2011

You Want to Feel Healthy Again, Lose Weight, Sleep on

What we do with our bodies begins when we are young and continues as we age. Healthy nutrition, managing stress, avoiding toxic chemicals, balancing hormones that are out of whack and exercise are all important to keep us healthy and age as slowly as possible. It is never too late to adopt better habits. To restore metabolism and achieve ideal body composition and obtain optimum health is a journey that will give you tremendous rewards. Let me guide you into this area of medicine that is not always discussed with Standard of Care physicians.

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Thursday, November 3, 2011

Why Should We Worry About Menopause Symptoms?

We need to de-myth Menopause for both Women and Physicians. We are taught in medical school that menopause is no big deal and easy to treat. That's laughable. We are taught that our sex hormones are just for reproducing babies, fertility, and when we are done with our child bearing years why do we need them. We are taught that if we aren't having any symptoms we must be done with menopause. And yet, these women can't sleep, they have osteoporosis, they have mood problems, are on antidepressants, heart disease is around the corner, and so is memory loss. Menopause is PERMANENT and it means that estradiol and progesterone are gone. We are living longer and our system that makes our hormones is aging faster than we are dying. It is a degenerative aging of our reproductive system. We don't need to tough it out ladies. Another myth. Maybe because we were told that HRT is bad for us. That is due to the Women's Health Initiative Study on synthetic oral hormones; Premarin and Prempro. We are told HRT is not safe for us so just tough it out and here is your Zoloft or Prozac. What I believe is we need to treat the cause of menopause, not the symptoms. The cause is the loss of estradiol and progesterone in rhythmic cyclic levels.

We can do this together and I can teach you how to manage hormone replacement yourself with bioidentical hormone transdermal creams used in cyclic dosing. Without these hormones your body ages faster. Heart disease. Bone loss. Memory loss. Metabolism loss. Sleep disturbances. Just to name a few.

Let's educate ourselves women! Empower yourself with knowledge and spread the word.

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Wednesday, July 20, 2011

From TS Wiley reprinted The Estrogen Dilemma

Call my office Lombard (630) 627-3700 to set up an appointment or email me at

The Estrogen Dilemma

In the April 12, 2010, New York Times article The Estrogen Dilemma, researchers are discovering that estrogen, a hormone produced in your brain, keeps your mind healthy and helps diseases like Alzheimer’s  and heart disease.  The key here is the Timing Hypothesis, which is, "the proposition that estrogen could bring great benefit to a woman who starts it in her 50’s while having the reverse effect on women ten years older…other scientists know there are ways estrogen improves and protects the brain when it is added to healthy tissues.”

Thus stating estrogen when added to a healthy happy body can heal your body, where taking estrogen in a tired unhealthy body can hit cells that are already sick, thus not replenishing or strengthening the woman’s body.  

The study also goes on to feature the evolution of hormones from horse urine to yam/plant based topical creams.  At the Wake Forest University in North Carolina researchers have found that estrogen has had a tremendous influence against heart disease in women alone.

In T.S. Wiley’s Book, Sex, Lies, and Menopause, she states the Dying of Cancer is something we all fear.  Having a heart attack, although seems more remote, because we don’t hear about it on television everyday would probably kill us where we stand.  A doctor interviewed in the article stated that, “Heart disease ultimately kills many more women than all cancers combined, some doctors had also taken to urging older women, even those past menopause to start hormones for cardiac health purpose.”

The overall dilemma that most women face is how do they get prescribed hormones and where.  What type of hormone is right for them?  Is it estrogen, progesterone, testosterone or all of them?

The Wiley Protocol is the answer.  The Wiley Protocol restores your hormones back to the way you had them when you were young, in the way you had them when you were young, rhythmically!


Sunday, February 27, 2011

Why Do So Many Think Estrogen is Dangerous for Women?

I spend a lot of time pondering that question and trying to figure out how this fear franzy started with a hormone called estrogen? I'm of average intelligence and feel like I am a reasonable person who has a somewhat logical mind so when I think about the human body and how it works I do so with a logical way of thinking. I also have many years of medical training where I have additional insight into how the body works. And I'm still amazed that other logical, average intelligent people fear estrogen. Yet....and I'm sorry I have to say things like this....don't fear far worse things we ingest and expose ourselves to. And if you are one of these people, you know exactly what I am talking about. I'm not even going to name a few examples because I don't want the focus to go that direction. I want to focus on why estrogen is a part of who we are as women and to take it away or have it go away (i.e.menopause) is when health begins to slowly decline.

It just bothers me so much when I do an internet search on menopause or HRT and read some of the incredibly ridiculous options given to women to manage their symptoms. If only women understood how this wonderful hormone actually works they would laugh and ignore the stupidity of the suggestions offered by well intentioned (I hope) solutions. We need to do more than manage the symptoms of hypoestrogen, below normal estrogen levels, and treat the problem. A phrase I use often to my patients.

Synthetic drugs posed as hormones are not estrogen. Low doses of estrogen given in the same dose every day is not hormone replacement, it is symptom management.

I am 45 and I have the mind and body I had when I was 25 and that is because I'm healthy inside. My estrogen levels are normal. My metabolic chemistry is normal. I don't suffer from hot flashes. I sleep at night. I don't have headaches. I have plenty of energy. My skin is smooth and supple. My hair is soft and full. My eyes are not dry. My stomach is flat. I don't have panic attacks or heart palpitations. I have a memory. I can multi task.

I know you want all these things too. And you can have them. Just don't be afraid of your estrogen.

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Friday, February 4, 2011

Studies Are Showing Bioidentical Hormones ARE SAFE!!

Americans are becoming more and more aware that there is a new approach to aging and are taking action to reverse the process of aging.

As I've written in many of my blogs about in successful anti-aging begins and ends with bioidentical hormone replacement. The effects of real hormone replacement are so remarkable and life altering (for the better), that it threatens big business (i.e. look at the losses of Wyeth (now owned by Pfizer) from the Women's Health Initiative study on HRT). As a result, the opposition continues to discredit the theory of restoration to optimal health through hormone replacement. Big business realizes that if we all get to feel this good on real hormone replacement then we won't need many (or any) of their drugs. But as information infiltrates through books from many great authors on the subject millions of people are now choosing restoration and in doing so realize that we can not only turn back the clock but in many cases eliminate degenerative disease risk---and with it the subsequent need for hospitalization, toxic drugs, and nursing home confinement.

I have been attacked for offering information on this 'other way' to age, through hormone replacement, avoiding pharmaceuticals unless absolutely necessary, and eating good, real, nutritious food. It makes one wonder what I am espousing that bothers everyone so much. There are studies for hormones that are never talked about in the big business world because they don't want you to know the results of those studies. If they did, then the companies who make synthetic hormones would do their study against bioidentical hormones and give us the results.

The data compiled by scientific experts who disagree with the absurd notion that aging humans should stand by and do nothing to reduce their risk of degenerative disease and claim that natural approaches are not effective in maintaining optimal health and can cause disease is amazing to me.

My position: I believe that bioidentical female hormone replacement offers significant safety and efficacy advantages over conventional hormone replacement therapy.

What my critics say: There are no published studies in peer-reviewed journals showing that bioidentical hormones are safer than other menopause treatments.

My rebuttal to the critics: I have always said that based on the peer-reviewed data, that non-bioidentical progestin increases cancer risk, while bioidentical progesterone does not. A review of the peer-reviewed literature supports this position.

In fact, at least thirteen studies document that non-bioidentical progestin significantly increases estrogen-stimulated breast cell replication and growth.{References: Climacteric. 2002 Sep;5(3):229-35.; J Steroid Biochem Mol Biol. 2005 Jul;96(2):95-108.; Breast Cancer Res Treat. 2001 Aug;68(3):187-98.; J Clin Endocrinol Metab. 1999 Dec;84(12):4559-65.; Cancer Res. 1992 Dec 1;52(23):6539-46.; Mol Cell Endocrinol. 1994 Jun;102(1-2):45-52.; Cancer Res. 1990 Dec 15;50(24):7858-62.; Biochem Biophys Res Commun. 1987 Jun 15;145(2):706-11.; Br J Cancer. 1993 May;67(5):945-52.; Breast Cancer Res Treat. 2007 Jan;101(2):125-34.; Breast Cancer Res Treat. 1998 Apr;48(3):221-9.; Am J Obstet Gynecol. 1996 Jan;174(1 Pt 1):93-100.; Cancer Lett. 1986 Feb;30(2):213-8.}

In stark contrast, at least seven studies have shown that bioidentical PROGESTERONE does NOT induce estrogen-stimulated breast cell proliferation. {References: Fertil Steril. 1995 Apr;63(4):785-91.; Fertil Steril. 1998 May;69(5):963-9.; Climacteric. 2003 Sep;6(3):221-7.; Jpn J Cancer Res. 1985 Aug;76(8):699-704.; J Gynecol Obstet Biol Reprod (Paris). 1990;19(3):269-74.; J Steroid Biochem Mol Biol. 2000 Jun;73(3-4):171-81.; Breast Cancer Res Treat. 1986;8(3):179-88.}

Numerous studies have demonstrated an increased risk of breast cancer with the use of non-bioidentical progestins. {References: 25. Int J Cancer. 2005;114:448-54.; JAMA. 2003 Jun 25;289(24):3243-53.; Cancer Causes Control. 2002 Nov;13(9):847-54.; Br J Cancer. 2005 Jun 6;92(11):2049-58.; Br J Cancer. 2005 Apr 11;92(7):1293-7.; Cancer Epidemiol Biomarkers Prev. 2002 Jul;11(7):593-600.; Int J Cancer. 2004 May 1;109(5):721-7.; Maturitas. 2004 Sep 24;49(1):44-50.; Int J Cancer. 1999 May 5;81(3):339-44.; JAMA. 2000 Aug 9;284(6):691-4.; J Natl Cancer Inst. 2000 Feb 16;92(4):328-32.; Am J Obstet Gynecol. 2004 Apr;190(4):1141-67.; Obstet.Gynecol. 2002 Dec;100(6):1148-58.; JAMA. 2003 Jun 25;289(24):3254-63.}

However, the use of bioidentical progesterone has not been associated with an increased risk of breast cancer. Quite the contrary, research has revealed that bioidentical progesterone decreases the risk of breast cancer.

For example, in a study published in the journal Breast Cancer Research and Treatment, 80,000 postmenopausal women using various forms of HRT were followed for more than 8 years. Women who used estrogen in combination with non-bioidentical progestins had a 69% increased risk of breast cancer, compared to women who had never used HRT. However, for women who used bioidentical progesterone in combination with estrogen, the increased risk of breast cancer was eliminated with a significant reduction in breast cancer risk compared with non-bioidentical progestin use. {Reference: Breast Cancer Res Treat. 2008 Jan;107(1):103-11.}

In another investigation, researchers found a 40% increased risk of breast cancer for women who used estrogen with non-bioidentical progestin. Interestingly, in women who used estrogen combined with bioidentical progesterone, there was a promising trend toward a reduced risk of breast cancer, compared to women who had never used HRT.{Reference: Int J Cancer. 2005;114:448-54.} In essence, bioidentical progesterone appeared to protect women against the development of breast cancer. These findings confirm work done six years earlier that found a trend toward a reduced risk of breast cancer in 1,150 women using bioidentical progesterone, compared to non-users of progesterone. {Reference: Cancer Detect Prev. 1999;23(4):290-6.}

A 2004 study was published in the International Journal of Cancer reported on the use of hormone replacement therapy (HRT) and breast cancer incidence in 31,451 postmenopausal women. The analysis of the data determined that women who used estrogen did not have an increased risk of breast cancer, compared to women who never used HRT.{Reference: Int J Cancer. 2004 Oct 20;112(1):130-4.}

The increased risk of uterine cancer in users of non-bioidentical estrogen is well-established in the scientific literature.{Reference: Engl J Med. 1975 Dec 4;293(23):1167-70.; Am J Obstet Gynecol. 1977 Mar 15;127(6):572-80.; Am J Epidemiol. 2009 Jul 1;170(1):12-23.}

As I always talk about, women taking any kind of estrogen should balance it with the appropriate dose of natural progesterone (and definitely NOT synthetic progestins that have been shown to increase breast cancer risk).

I do not advocate the use of oral hormone formulations. I suggest the use of transdermal applications because of the safety benefits associated with topical (through the skin delivery) rather than oral hormone tablets.

My position: I strongly advocate for bioidentical hormone restoration therapy in the context of healthy lifestyle choices to include beneficial nutrients found in cruciferous vegetables shown in peer-reviewed, published studies to support healthy estrogen metabolism and high doses of supplemental vitamin D.

What my critics say: There still is not solid proof that bioidentical hormones won't cause some of the problems associated with FDA-approved unnatural-to-the-body estrogens and progestins.

My rebuttal to the critics: Estrogen is not one compound. It comprises different forms that metabolize in the body to ones that can either promote cancer or protect against it. Compounds found in cruciferous vegetables (such as cauliflower, broccoli, cabbage and Brussels sprouts) help neutralize an estrogen metabolite called 16 alpha-hydroxyestrone that promotes hormone-dependent tissue growth.

For example, major reductions in cancer risk and specific protective mechanisms against hormone-responsive cancers like breast cancer are observed with cruciferous vegetables {References: J Nutr. 2004 May;134(5):1134-8.; Nutr Cancer. 2002;42(1):1-9.; Cancer Res. 1999 Aug 15;59(16):3991-7.; Cancer Epidemiol Biomarkers Prev. 2000 May;9(5):477-85.; Mutat Res. 2007 May;635(2-3):90-104.; Cancer Res. 2005 Sep 15;65(18):8548-57.; Cancer Epidemiol Biomarkers Prev. 2000 Aug;9(8):773-9.; J Natl Cancer Inst. 1997 May 21;89(10):718-23.; J Cell Biochem.Suppl. 1997;28-29:111-6.}

Studies have also found a strong correlation between blood levels of vitamin D and the risk of breast cancer. A case-control study comparing 1,394 postmenopausal breast cancer patients with 1,365 controls showed that low blood levels of vitamin D were significantly related to breast cancer risk. In fact, women with the highest levels of vitamin D had a nearly 70% reduction in their risk of breast cancer, compared to women with the lowest vitamin D levels. {Reference: Carcinogenesis. 2008 Jan;29(1):93-9.}

Similar research examining the relationship between blood levels of vitamin D and breast cancer risk revealed that women with blood vitamin D levels of approximately 52 ng/mL had a 50% lower risk of breast cancer compared with women who had vitamin D levels below 13 ng/mL.{Reference: J Steroid Biochem Mol Biol. 2007 Mar;103(3-5):708-11.}

In another study, the effects of administering 1,100 IU a day of vitamin D were evaluated in 1,180 postmenopausal women. After only four years, the risk of developing any cancer was 60% lower in the vitamin D group, compared with those in the control group. {Reference Am J Clin Nutr. 2007 Jun;85(6):1586-91.}

We know that cancer results from the accumulation of mutations in genes that regulate cellular proliferation. As we age, we develop more of these mutations, thus placing us at far greater cancer risk. Vitamin D favorable effects hundreds of cell proliferation regulating genes and by this mechanism, confers substantial protection against breast and other cancers.

So in summary:

Given the above evidence, aging women should feel confident that bioidentical hormone replacement, when appropriately prescribed, offers a safer and potentially more effective alternative to conventional hormone replacement than with non-bioidentical hormone drugs to help relieve menopausal symptoms and optimize long-term health. The addition of several proven nutrients (such as vitamin D) to a bioidentical hormone regimen can help optimize estrogen metabolism and reduce cancer risk further offering a balanced approach to health maintenance.

Those critics who advocate that aging women can do nothing to forestall normal aging processes are condemning their followers to becoming statistics in mainstream medicine's anticipatory revenue assembly line. Drugs for symptoms. Continued aging requires more drugs. More revenue. Instead, I personally prefer to take affirmative steps to guard my health rather than do nothing but wait for premature disease and aging to strike.

I live by the rule of example...if others want what I have relative to health and vitality, then they can feel safe in doing what I do. Because as you can see from the research above, I do my homework.

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Friday, January 21, 2011

Wiley Protocol Testimonial from Current User of Bioidentical Cyclic Hormones

Wiley Protocol Hormone therapy has positively changed my life in so many
ways. I’ve been on the protocol for almost a year now and cannot say enough good
things about it. I had been diagnosed with early ovarian failure at the age of twentyseven.
Needless to say, there were many ways that my body was rebelling against the
hormonal imbalance. For the better part of ten years, I struggled to find the right
hormone replacement. All of the options that had been given to me only consisted of
various types of birth control pills. I switched pills multiple times, trying to find the pill
that made me feel like the ‘real’ me. Little did I know at the time, the reduction in
estrogen and progesterone affected me more than I realized. Slowly but surely, after
taking pill after pill, I just started to fall apart – physically, mentally, and emotionally.
I learned about The WP when I went to a new doctor for joint pain. Her advice
was that I needed a better hormone replacement. It was hard for me to believe that a
hormonal imbalance could be the cause of my discomfort but she assured me that this
was the case. Initially, I felt a bit overwhelmed to learn about how the program worked;
using the different creams in different amounts, on different days, and in cycles. It then
donned on me that the easy, daily pill-popping was not working and hadn’t been for a
long time. What did I have to lose? So, I then began The Wiley Protocol. With in a few
weeks many things started to change for the better. While using WP hormones, I began
to have improvements in symptoms that I didn’t realize were related to hormonal
Along with the diminishment of joint pain, I also noticed; I have an increased sex
drive, blood pressure readings that are similar to pre-pregnancy rates, less frequent bouts
with anxiety, improved critical thinking, and noticed that I feel more emotionally levelheaded.
Not to mention, I not longer have ANY hot flashes! Not only have I realized
these improvements but so have many of my friends/family as well. They say I seem
much more relaxed and calm. I’ve even been informed by my husband that under no
circumstance is it acceptable to discontinue using these hormones. I am so grateful to
have found Wiley Protocol Bio-identical Hormones. They are just what I was looking for
– they’ve helped me find the ‘real’ me again.

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Saturday, January 15, 2011

The Connection between Cancer and Hormones blogged by TS Wiley

The Connection between Cancer and Hormones

Dr. Brawley, another doctor, states that mammography misses most cancers, “and that radiation from the scans will actually cause some cancers to develop. In addition some women will be called back repeatedly for additional procedures, scans, and biopsies that ultimately rule out cancer but can be painful and anxiety provoking. Mammograms also find some cancers that grow very slowly but look the same as any other cancerous tumor, leading to aggressive but unnecessary treatment.”

The connection once again is hormone fall-off. We at The Wiley Protocol believe the connection between breast, uterus, and ovarian cancer is the hormones and regulation of the hormones within the body. We believe multiple cancers arise as we age because of the fall off of hormones. Women quite naturally fall apart as they get older, devolve, and in the absence of hormonal control lose their sense of vitality. Using X-rays to see abnormalities in breast tissue has been around since 1913, but had never become a diagnostic tool since the mid-1970’s. The statistics proven and tested show that early detection is worthless because breast cancer, statistically, kills half of all women diagnosed with it within five to ten years after diagnosis no matter how early its detected. The statistics have never changed. If women never experienced the hormonal fall-off known as menopause, these cancers might never develop.

The heated debate right now among the new guidelines that made Dr. Weiss furious was the American Cancer Society stated that women should limit their mammograms. The reason for this is because it saved her own life, but the question pending is will it save another life or cause more ionizing radiation to the next woman in line?

The trend is disturbing: because of the radical changes in the way women live — earlier puberty, rising obesity and alcohol consumption, environmental pollution, long-term use of oral contraceptives, later childbearing and less breast-feeding — could lead to more breast cancer emerging at younger ages.. So the key we believe at the Wiley Protocol is to get more sleep, drink clean water, buy hormone free meat and organic food as much as possible and when needed restore your hormones back to the way you had them when you were young.

To learn more about these issues please ready both my books Lights Out, Sleep, Sugar and Survival, and Sex Lies, and Menopause, The shocking Truth about Hormone Replacement Therapy

Call my office in Lombard (630) 627-3700 to set up an appointment or email me at

Friday, January 14, 2011

Check out the Wiley Protocol Blog Page

Copy and paste the above link into the browser and read an interesting article about Cancer

Call my office in Wilmington (815) 476-5210 or Lombard (630) 627-3700 to set up an appointment or email me at