Thursday, December 20, 2012

Getting Through the Holidays with Chronic Illness (Plus Bonus Quiche Recipe!)

Holidays with Chronic Illness
I spend a lot of time with patients on the phone this time of year. I know I am busy, but the holidays can be overwhelming for someone with a chronic illness like interstitial cystitis, so I do my best to help them.

Today, I had a heart-to-heart conversation about the holidays with an IC patient (she also has multiple conditions including chronic back and neck pain). Near the end of our call, she said, "I don't feel guilty about not being able to do everything; I am over that. But I spend a lot of time in my head dwelling on the fact that people are judging me." I asked what she meant about that, and she said she "sees" disappointment in people's faces that she can't participate like she used to.

This reminded me of a Dr. Oz segment I saw earlier this week where he interviewed Christine Carter, PhD. The topic was "Things that block us from being happy the most." Here is what his guest had to say:
  1. Perfectionism (which is basically living in a continual state of "not good enough."
  2. Materialism (always thinking of what you can get rather than what you can give), and
  3. Entitlement (more likely to feel disappointed when we don't get what we want than we are to feel grateful when we do).

Now, I realize that is all easier to say than it is to correct. In fact, I was watching the recorded show while I was wrapping Christmas presents at 1 am. It was just what I needed to hear. The tape dispenser was not cooperating, and I realized I hadn't purchased bows. Perfectionism for me this time of year mostly revolves around: Are the packages going to look perfect? Am I going to have the right food? Or I read our Christmas letter again and again wishing I had said something or not said something else. It is so easy to get trapped in all of that and more when when we see our magazines full of perfectly set tables, photo worthy food, gorgeous hand cut Christmas cards, and perfect homemade gifts. 

I think I get trapped in reverse materialism...which seems to me just as damaging...."Am I giving enough? Maybe I should get just one last gift card for the kids. Does everyone have the same number of presents? Will this be as good as last Christmas?" 

And the entitlement isn't about gifts either for me......I think for many women, it is easy to fall into the trap of, "Well I did all of this for you, so you should praise me and be thankful and do your part to make the holiday perfect." We need to give without expectation of thanks. Not to say my family isn't appreciative and grateful. Quite the opposite. But if we are waiting for the exact right phrase, or the hand written thank you (when someone wrote a lovely email or text of thanks) or if we didn't get thanked "properly" for that one item we took months to find...well that is a trap. So........this year no bows.......and the corners of the packages are mashed together. I think we will still enjoy Christmas. 

In the end, I wonder if our view of the holidays is skewed by our own view of things, and maybe as the psychologists say, we need to change ourselves so that others view us differently. 

Do you feel guilty around the holidays because you are "sick"? Do you spend "a lot of time in your head" thinking people are judging you? Do you think this is more a reflection of what you feel, or is it true, people judge you? If so, let's brainstorm ways to get over that so we can all enjoy the holidays! You deserve a lovely holiday just like everyone else!

PS: To see Dr. Oz and Dr. Carter talk about how to boost your happiness, check out a video from that segment here: http://www.doctoroz.com/episode/dr-ozs-happiness-boosters. Also see my previous blog post, Bringing the Ho-Ho-Ho Back to the Holidays. 

BONUS: Christmas Day Breakfast Recipe from Confident Choices: A Cookbook for IC and OAB:


Spinach and Feta Quiche



Ingredients

·          2 (10 oz.) pkg. frozen chopped spinach (thawed)

·          5 eggs

·          1 c. half and half (may substitute 1 c. evaporated skim milk)

·          1 c. crumbled feta cheese (4 oz.)

·          2 T. chopped green onions

·          1/2 t. lemon zest, if tolerated

·          1/2 t. salt

·          1/4 t. pepper
·          1 unbaked 9-inch pie shell (may use refrigerator or frozen dough)

Pierce bottom of pie shell and bake for 5 minutes at 350°F. Cool slightly. Raise temperature of oven to 400°F.

Drain spinach and press out all liquid. (This can be done easily between layers of paper towels.) Set aside.

Whisk eggs and half-and-half or milk in bowl. Add cheese, green onions, lemon zest, salt, and pepper. Pour into partially baked pie shell. Bake on middle rack, 400°F for 10 minutes, reducing oven temperature to 350°F for the last 25 minutes. (Note: the timing seems to be different every time for me. Test frequently like you do a cake. Put a dry strand of spaghetti in the middle and see what it looks like when you bring it out. It should be moist, but not dripping with egg mixture.)

Broccoli and Cheese Quiche:  Substitute 1 cup frozen broccoli florets for the spinach and 1/2 cup mozzarella or cheddar cheese for the feta cheese.

Don't need the whole cookbook? Try the Confident Choices e-books

Julie Beyer, MA, RDN
Author, Speaker, Patient Advocate

http://www.amazon.com/exec/obidos/ASIN/0976724626/ref=nosim/nutraconsults-20 Just Tell Me What to Eat!

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder

For health care workers:  Interstitial Cystitis: A Guide for Nutrition Educators




 **Please SHARE using the links below!**

Monday, November 12, 2012

Are You Sick and Tired of Being Sick and Tired? How to Get More Energy Without Caffeine!

Smelling lemons can help wake you up!
Citrus scented lotions can awaken
your senses without caffeine!
One of the most common questions I get from my IC diet coaching patients is "How can I get more energy if I have to give up caffeine?" 

Trust me, I hear every word you are saying. Although some IC patients do ok with low acid coffee, most interstitial cystitis patients need to give up coffee entirely.

There are many things that can contribute to fatigue when you have IC. Obviously, the quality of sleep is compromised if you are getting up several times at night to use the bathroom. In addition, many of the medications patients use, including narcotics, anti-anxiety medications, and antihistamines cause drowsiness. Even the mental activity of navigating all the changes associated with being diagnosed with a chronic illness can be exhausting.

How does a person deal with such a situation? Trust me, it is far from hopeless. Here are some suggestions:   
  1. Work with your physician. Once you rule out any other medical conditions, ask if you can take less medication that contributes to drowsiness if you can get your symptoms under control by modifying your diet.
  2. Nurture a positive attitude about giving up caffeine. Remind yourself that this is something you can control, unlike many other aspects of the disease.
  3. Establish regular sleep habits. Most people, sick or not, require at least 8 hours of sleep at night. If you know you will spend a portion of that in the bathroom, plan to “sleep” even longer.
  4. Take mini-naps during the day if necessary. Find a quite place to lay your head down for a few minutes. Set the alarm on your cell phone for 15 to 20 minutes. When you consider that you are much more alert after these mini-naps and accomplish more, the time is worth it.
  5. Eat smaller, well-balanced, low fat meals. High calorie meals can slow even the healthiest person down as the body diverts energy to the process of digestion. Have a handful of high protein nuts or vitamin packed carrots as an afternoon snack instead of a handful of sugar cookies.
  6. Drink plenty of water. One of the first signs of dehydration is fatigue. You may have kicked the caffeine habit, but have you developed a water habit?
  7. Use a small personal fan in your workspace. The cool air movement can keep you feeling more alert.
  8. Expose yourself to bright lights. If you have a choice, move your desk near a sunny window. If that isn’t possible, ask to have brighter lights installed in at least part of your workspace.
  9. Use citrus scented hand lotions. That burst of citrus as you moisturize your hands can wake you right up! I have citrus lotions all over the place, in my home, in my car, and in my purse. You can find them in specialty stores like Bath and Body Works, Body Shop (try the Bergamot), and William Sonoma. Lotions with a strong minty scent work good too!
  10. Watch your posture. Sit up tall! Don’t make your lungs and heart work harder than they have to. Just sitting tall can give you the feeling of having more energy.
  11. Get regular exercise. One of the first things we are tempted to give up when we are tired is exercise, when that is the opposite of what we should do! As you make the rest of your body stronger, it becomes more efficient at accomplishing everyday tasks. In fact, people who are fit often report needing less sleep than their out-of-shape neighbors do.
  12. Finally, find a way to stimulate your funny bone. Many times when we live with a chronic illness, we forget to enjoy some of the simpler things in life. Watch funny television shows and movies instead of draining yourself with emotional dramas. Subscribe to a joke of the day to great you each morning in your email. Find an excuse to laugh every day!
Adapted from the forthcoming book: Living Positively with Interstitial Cystitis: A Confident Choices Book by Julie Beyer, MA, RD.

If you need help getting more energy without caffeine, please don't hesitate to contact me at NutraConsults@aol.com  for a personal consultation. A one hour phone consultation CAN make a difference in your life!

Author, Speaker, Patient Advocate

Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder



 **Please SHARE using the links below!**

Thursday, September 20, 2012

Interstitial Cystitis Diet? Trust Your Intuition!

Baking Bread
Oh my gosh, today there was a big discussion on one of my dietitian lists about gluten-free diets being used for IC. Although most people appreciated my level head when it came to the topic, it still frustrates me when people are so quick to promote something that has NO substantial research behind it. One dietitian said erroneously that 80% of IC patients have gluten sensitivity. When challenged, she couldn't substantiate that number. Well, of course she couldn't. It IS NOT TRUE!

I wrote about this in April of this year (Gluten-Free Diet for Interstitial Cystitis/Painful Bladder Syndrome), and still refer to it often when answering posts at the Interstitial Cystitis Network and on my facebook pages, Trust me, I understand the desperation that makes people believe that if they change their diet dramatically, they could cure their IC symptoms. But in my 14 years of dealing with thousands of IC patients, I just have not seen it!

I wanted to update the topic because I had to do more research to have this "discussion" with the dietitians. To be honest, nothing has changed. The ONLY statistics I could find are from an online poll done by the ICA:

 "More than 1,000 interstitial cystitis (IC) patients completed an Interstitial Cystitis Association (ICA) quick poll on gluten sensitivity and celiac disease:
  • 12% of IC patients reported being diagnosed with celiac disease, a gluten-intolerance condition.
  • 15% of IC patients stated that foods with gluten bothered their IC symptoms."

Keep in mind, that this was a self-reported survey (far from scientific) and these people may or may not have already been influenced by the flood of fad diet information out there about gluten in our food supply. And, although this page on the ICA states that there is research pending, I am having a hard time putting any value in a study that only includes 39 people when I have dealt with thousands of patients over the past 14 years. 

That being said, I know we have a LONG way to go with IC and diet research. This is made difficult because IC is likely not one disease, but several that we have lumped into one category. Treatment, including dietary treatment, is extremely individual.

My current recommendation with patients who come to me wanting to try a gluten-free diet is to have them try it for two weeks. If they do not have some relief during that time, we go back to eating foods that have gluten in them. It is never a good idea to eliminate entire food groups from your diet unless it is truly a medical necessity.

I believe in most patients' abilities to trust their own intuition as far as diet is concerned. In reality, bread and other gluten containing products are nearly always reported by patients to be some of the least bothersome foods for interstitial cystitis/painful bladder patients. Instead, research has shown the most bothersome foods for interstitial cystitis/painful bladder patients to be: 
  • Caffeinated beverages
  • Citrus fruits and juices
  • Alcoholic beverages
  • Carbonated beverages
  • Tomatoes
  • Foods containing hot peppers
  • Certain artificial sweeteners
  • Pineapple/pineapple juice
  • Cranberry juice
  • Horseradish
  • Vinegar
  • Pickled herring
  • Soy
For those of you more interested in this topic, I have a book written for dietitians that explores the research in more depth than my books for patients. If you don't have it already, you might be interested in Interstitial Cystitis: A Guide for Nutrition Educators:

I KNOW we have a long way to go with reseasrch on the IC Diet, but we are not going to get anywhere by continuing to disseminate poorly researched theories. Help pass the work. Send this link to your IC friends and post it in your groups. And PLEASE don't eliminate entire food groups from your diet unless you are really helped by it. An IC Diet is not "one-size-fits-all," but rather an individualized diet that can be determined by a deliberate process of trial and error. If you need help determining your personal trigger foods, please don't hesitate to contact me at NutraConsults@aol.com for a personal consultation.

Julie Beyer, MA, RDN
Author, Speaker, Patient Advocate

http://www.amazon.com/exec/obidos/ASIN/0976724626/ref=nosim/nutraconsults-20 Need More Recipes? Check Out A Cookbook for IC and OAB!

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.



For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder
For health care workers:  Interstitial Cystitis: A Guide for Nutrition Educators 


 **Please SHARE using the links below!**

Tuesday, September 4, 2012

Vulvodynia and Interstitial Cystitis



Vulvodynia and Interstitial Cystitis
What is Vulvodynia? Vulvodynia, or chronic pain in the area around the vagina (vulva) is often seen in interstitial cystitis patients. The characteristic symptoms of burning or irritation of this sensitive area can crossover with those of IC. Women with vulvodynia can find sitting for long periods of time and sexual intercourse extremely uncomfortable. The condition is considered chronic with symptoms lasting years.

The Low Oxalate Diet: Many patients report some relief when following a low oxalate diet. Oxalates are tiny molecules found in various foods that generally pass through the body unabsorbed. In some patients, however, oxalates can pass through the intestinal barrier and the molecules accumulate causing inflammation in various areas of the body. To date, researchers have not proven that oxalates play a part in vulvodynia; however I truly believe that patients know best and the researchers need to keep looking!

Finding Personal Trigger Foods: If you have vulvodynia in addition to IC and you want to try to eliminate oxalates to see if it helps your symptoms, you can combine both the low oxalate food list with the IC Food List. Compare the lists, crossing out foods on the IC Food List that are high (H or VH) and moderately high (M) in oxalates. This will give you a basic diet to follow to see if your symptoms improve. After some time, you can experiment with adding some of the M foods back in to see if you react. The important thing is to develop your own, personalized trigger food list and not eliminate foods unnecessarily.

If you need to combine a low-oxalate diet with an IC Diet, I suggest that you consult a dietitian. I have helped many IC/vulvodynia patients over the years. If you are interested in a consultation, please email me at NutraConsults@aol.com. If you would rather see someone in your area, please email me and I can find someone to help you. 

Treatments for Vulvodynia: Medical treatments include tri-cyclic antidepressants and antihistamines to help reduce pain and inflammation. Vulvodynia patients may also find relief from creams such as lidocaine that temporarily numb the area. Surgery should be considered a last resort and may include removal of the painful areas of the vulva.

Additional Lifestyle Changes: Many patients find they can treat their symptoms with various lifestyle changes. MayoClinic.com recommends cold compresses to the affected areas, avoiding tight fitting clothing, avoiding hot tubs, limiting excessive personal hygiene, and paying attention to other triggers such as personal hygiene products and toilet tissues. 
Some people with vulvodynia take warm baths with a handful of Epsom salts in it to relieve their symptoms. You may also want to use personal lubricants. I LOVE the Desert Harvest Aloe Gele'! It is actually the reason why I decided to write this article! I keep it in the refrigerator since the coolness also seems to help. Desert Harvest also has a Desert Harvest Aloe Gel that doesn't use any preservatives. Again, an excellent product that has helped many IC and vulvodynia patients. 

Desert Harvest Gele
[More product information: Both Desert Harvest's All-Natural Aloe Vera Personal Gel and Desert Harvest Gelé contain all of the anti-inflammatory,pain relieving, and healing properties of the aloe plant without paraben preservatives. The difference between the two is the concentration. DH Gelé starts with 10X concentrated aloe vera juice, while the DH Personal Gel uses 1X juice, which means the Gelé is more therapeutic and healing. The Gelé is 95% natural with small amounts of manmade preservatives. The Personal Gel costs a bit more because it uses 100% botanical preservatives. Many thanks to Desert Harvest for their support of the Confident Choices mission!]

For more information and personal support check out the Interstitial Cystitis Network's Vulvodynia Support Forum

Author, Speaker, Patient Advocate

Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder



 **Please SHARE using the links below!**

Tuesday, July 24, 2012

Interstitial Cystitis Diet and Overwhelm


should I eat it? interstitial cystitis
I often get frantic calls from interstitial cystitis patients who are overwhelmed trying to figure out what they can or cannot eat.  Trust me, I totally get it. Early on I was frustrated about the IC diet, ending up in a negative cycle of fixating on the foods I couldn't have, thinking I already had to give up so much of my life, and now I can't even have spaghetti or orange juice. How am I going to handle this?

Despite the frustration; however, the key thing to remember is that dietary modification CAN help control symptoms of IC, and it is actually something we have in our control. The one thing that helped turn my head around was to realize that eventually everyone "gets" something. Some people get arthritis, some get diabetes, some have even worse diseases like cancer.


In fact, if you asked ten people on the street if they are supposed to be watching their diet in some way, nine out of ten would say yes . . . and the last one would most likely be lying!


The good news is that an individual's IC diet usually doesn't have to be as strict as you may think. Most people with a painful bladder or interstitial cystitis find that they can have a substantial and healthy diet if they do a little detective work to identify their personal trigger foods. That is the idea of the IC elimination diet. Most people do not have to be on the most restrictive diet forever. And, although others with IC are great counsel, your diet is probably not going to look like anyone else's.


It can be very helpful to remember that eventually you will feel normal again, or more accurately, you will find yourself accepting a "new normal." You will learn coping skills that will help you on a daily basis. You will be able to navigate your refrigerator and restaurants without putting yourself in a flare. You will find exercises that you can do, and fixate less on what you can't do.


So, if you are new . . . hang in there . . . ask questions . . . be your own best health care provider. Keep a diary or a calendar. Write down what you eat, what is going on in your life, the medications you are trying, and how you are feeling. If you can't figure it out, share your diary with a trusted friend or your doctor. Sometimes we are too close to a situation to see what may be hurting us.


The ultimate message here is that you CAN do it, you CAN get better, you CAN begin to heal . . . it just takes some time and patience.


For more help see:  
Customizing the Interstitial Cystitis Diet: A Confident Choices Book


Author, Speaker, Patient Advocate

Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder



 **Please SHARE using the links below!**

Thursday, July 12, 2012

Interstitial Cystitis and Stress: Can Stress Affect Your Bladder?

stress and interstitial cystitis

When I speak to interstitial cystitis support groups, I often tell a story that took place shortly after I was diagnosed for my painful bladder. (If you have heard this story before, please bare with me.)

We had just moved into a new house and took a weekend to wallpaper the kitchen. As many of you can relate, putting up wallpaper can definitely test a relationship! In fact, things were going along just fine until my husband lost his temper briefly about something. I literally doubled over with bladder pain, and he snapped again, "But you were fine just a second ago!"

Yes, I was fine just a second ago, but this scenario was the biggest example yet of how quickly stress can affect our bodies, particularly if you have a condition like interstitial cystitis.

What Is Stress?


Despite all of the psychological talk these days about stress, many people are still not sure what it means and how stress can affect a condition like interstitial cystitis. For example, stress itself is neither negative nor positive. Instead, it is our reaction to stress that turns stress into “dis-stress.” Most interstitial cystitis/IC patients learn early that stress can aggravate their bladder symptoms. Please understand; this is not the same as saying that your symptoms are all in your head. Stress, more exactly the body’s response to stress, produces chemical and physical changes that cause our bodies to react in ways that are intended to protect us, but they can also cause damage to our bodies, including our bladder.

The first thing to keep in mind is that stress can be either “external” or “internal.” Examples of external or physical stress include loud noises, extreme heat or cold, malnutrition, injuries, illnesses, toxins, travel, heavy labor, exercise, harsh weather, smoking, and drug or alcohol use. Internal stress can include emotions like anger, resentment, envy, revenge, tension, anxiety, excitement, guilt, fear, rejection, failure, success, depression, love, joy, expectations, boredom, and even frustration. If you are surprised about the positive emotions being listed there, consider the stress people experience when planning weddings or building their dream house!

 

Fight or Flight


To understand how these stresses create problems in our body and particularly our bladders, it is important to understand the physiological reaction to stress. 

Imagine that a fire spontaneously breaks out in a store where you are shopping. Some of the people around will call 911; some will work to fight the fire; and some will flee, or run from the scene. The body’s physical responses to this stressful situation (the “fight or flight” response) include:
  • Increased release of stress hormones—frequently triggering IC symptoms
  • Surges of sugar released into the bloodstream—providing quick energy for muscle and brain functions
  • Accelerated heart rate, increased respiration, and increased blood pressure—improving the flow of oxygen and energy to the muscles and brain
  • Increased cholesterol and blood lipid levels—providing a sustained form of energy
  • Increased blood clotting ability—preparing the body to heal potential wounds from “fighting”
  • Increased sweating—keeping the body cool during “battle”
  • Dilation of pupils—maximizing vision
  • Slowed digestion and reduced immune function—allowing the body to focus energy on the “stressful” event
Although all of these physical reactions are valuable when a fire breaks out, many times the stressful events we experience do not require the same level of physical activity that fighting a fire demands. For example, when you are subjected to pressure at work, it is unlikely that you will physically have a fight with your boss. Or, if you are in a traffic jam, you probably are not going to get out of your car and start running. Yet, in each case, your body goes through all of those physiological and chemical changes of stress.

This unmanaged stress negatively affects body systems. Many of these changes can affect your bladder if you have interstitial cystitis or even overactive bladder! Nutrition resources are depleted rapidly. The risk for heart disease and stroke increases. Headaches and muscle aches are more common in people under stress. Both men and women can experience fertility problems, and the body is more susceptible to illness (cancer, infection, colds, and flu) because of a weakened immune system. 

Knowing this, now you can probably see how so many health problems are stress related. People under stress are more susceptible to ulcers and irritable bowel disease. Bingeing behavior can increase after a stressful episode, making weight management difficult. On top of that, stress hormones encourage fat to be stored. Finally, as most IC patients know, unmanaged stress can cause an increase in urinary symptoms. 

 

Managing Stress to Manage Your Bladder Symptoms

 
“I believe that a simple and unassuming manner of life is best for everyone,
best both for the body and the mind.”
Albert Einstein

  • Taking action if possible: Procrastinating on a project or sweeping problems under the rug only increases stress in the long run.
  • Committing to a healthy diet: A healthy diet not only keeps the body from going into stress related to malnutrition, but it also reestablishes nutritional balance when nutrients are depleted, and fortifies the immune system.
  • Getting up to move: Exercising gives the body something physical to do when it is in a state of stress and reduces the effects of stress by using up the chemicals released in the “fight or flight” phenomenon.
  • Avoiding the temptation to “relax” by using alcohol or drugs when under stress: These substances only increase stress on a body.
  • Practicing deep breathing, yoga, massage, meditation, or prayer: hugging someone; playing with a pet.
  • Putting your problems into words: Talking to someone or writing the thoughts down can help provide perspective.
  • Practicing forgiveness: Forgiving those who have hurt you and forgiving yourself for not being perfect can help you come to a place of acceptance.
  • Enjoying something “new”: Taking up a craft, or enrolling in a class can help you feel a sense of accomplishment.
  • Letting go when the situation cannot be changed: Putting problems in the past is much healthier than obsessing about problems that can never be solved.
PS: I just wanted to assure you that the wallpaper turned out beautifully! In fact, that was about 12 years ago, and we have redone the kitchen again with nary a cross word! :-)

FOR MORE INFORMATION ABOUT STRESS AND INTERSTITIAL CYSTITIS SEE:


Author, Speaker, Patient Advocate

Helping Yourself Is the First Step to Getting Well

For step by step guidance for creating your own personal interstitial cystitis meal plan, see: Confident Choices®: Customizing the Interstitial Cystitis Diet.

For some basic, family-style, IC bladder-friendly recipes, see: Confident Choices®: A Cookbook for Interstitial Cystitis and Overactive Bladder



 **Please SHARE using the links below!**