By: Dr. Lynn Lafferty & Nicole Simone

The Sockeye salmon, or Oncorhynchus Nerka, is the smallest most delicate of the Kenai Wild salmon family. These wild pacific salmon are the most sought after salmon in Alaska due to their unique flavor and bright red, extra firm texture. The average size is 6 – 9 pounds and they can measure up to 2.8 feet.  Sockeye salmon are typically seen in south central Alaska in late May until early August. One half pound of sockeye fillet has about 332 calories, 42 grams of protein, 2.9 grams of saturated fat, and 93 mg of sodium. Unlike farm-raised salmon, wild sockeye salmon are drug and antibiotic-free, have higher levels of beneficial Omega-3 fatty acids, as well as, lower levels of saturated fats. These fish have beneficial amounts of selenium, protein, niacin, Vitamin B12, phosphorus, magnesium, and Vitamin B6. It is also one of the few protein sources with alkaline verses acidic properties.

The biggest health benefit from sockeye salmon comes from the superior amount of Omega 3 fatty acids. In fact, this type of salmon has the highest content of Omega-3s verses any other fish. These fatty acids are extremely beneficial for the heart, have natural anti-inflammatory healing properties, and are necessary for the creation of healthy cell walls within your body. Research has shown that Omega-3 fatty acids decrease risk of arrhythmias (abnormal heartbeats), which can lead to sudden death.  Omega-3 fatty acids also decrease triglyceride levels, slow growth rate of atherosclerotic plaque, and lower blood pressure. Additionally, Omega-3s also have an anti-aging effect by improving skin tone, as well as, hair and nail texture and growth rates. People consuming high amounts of Omega-3 have reported less joint pain and stiffness. Omega-3s also have a favorable effect in breast cancer. They have been proven to delay tumor appearance and decrease the growth, size, and number of tumors. They also are beneficial in regards to mental health. Decreased feelings of depression, decreased symptoms of Autism Spectrum Disorder, ADD/ADHD, as well as, lower risks for dementia and Alzheimer’s disease were seen in people who consumed high amounts of Omega-3 fatty acids. To receive all these benefits it is widely recommended to eat fatty fish, especially salmon, at least twice a week. Here at the Robert Fishman Institute, we also believe in supplementing your diet with an Omega-3 to achieve optimal results.

Drawing of ocean phase Sockeye (red) salmon (Oncorhynchus nerka). These fish are packed with Omega 3s, protein, vitamins and minerals.

When comparing wild salmon to farm-raised salmon, the health benefits are far and away superior. Wild salmon contains no added chemicals, no artificial coloring, no preservatives, no growth hormones, no antibiotics, and no GMOs. To give an eye-opening comparison, listed below is the scary truth of farm raised salmon:

• At salmon farms, thousands of salmon are kept in net pens, endangering the health of the fish as well as the surrounding waters.
• Farmed salmon are frequently fed antibiotics, which contribute to the growth of drug-resistant bacteria in humans who consume them.
• Farmed salmon is much higher in saturated fats than wild salmon. Saturated fat is a known contributor of health problems in humans. Farmed Atlantic salmon contain 70 percent more fat than wild Atlantic salmon and 200 percent more fat than wild Pacific salmon. Also, farm-raised salmon have been found to contain significantly higher concentrations of PCBs, dioxin, and other cancer-causing contaminants than salmon caught in the wild.
• The study, A Global Assessment of Organic Contaminants in Farmed vs. Wild Salmon: Geographical Differences and Health Risks, which is being considered the most thorough analysis of farmed and wild salmon to date, found in most cases that consuming more than one serving of farmed salmon per month could pose unacceptable cancer risks, according to United States Environmental Protection Agency (EPA) standards for determining safe fish consumption levels. Farmed salmon were found to have up to 10 times higher levels of PCBs and dioxins than wild salmon.
  • Farmed salmon are administered chemical dyes to color their flesh a salmon pink. Without this dye, a farmed salmon would be an unappetizing grayish-brown. Wild salmon has a much better texture than farm-raised fish, which tend to be mushy and bland.

References:

1.    www.wildpacificsalmon.com

2.    www.kasilofseafoods.com

3.    www.wikipedia.org

4.    www.americanheart.org

The Robert Fishman Institute Dietary Recommendations for Achieving Your Optimal Weight & Well Being

AVOID

• White Potatoes
• White Rice
• Pasta
• Bread containing wheat
• White Sugar
• Soy

CONSUME

• Vegetables (preferably organic)
  

  Add a teaspoon of raw blue agave to a baked sweet potato for a delicious and healthy alternative to white potatoes.

• Fruits (preferably organic)
• Beans
• Nuts
• Sweet Potatoes
• Brown Rice
• Chicken (hormone free)
• Beef (hormone free)
• Fish (not farm raised)
• Eggs (free range, organic, hormone free)
• Butter (raw where possible, if not organic)
• Cheeses (Imported, NOT processed)
• Oatmeal (NOT instant)
• Acceptable Breads: Ezekiel, Spelt, Rye
• Milk: Cow (raw where possible, if not organic), Goat, Almond, or Rice

We do not recommend consuming products made with wheat. The reason we want consumers to avoid wheat, is because the gluten within the wheat is very damaging to our gastro-intestinal tract. Also much of our wheat has been genetically modified. Wheat gluten may cause of the following disease-states:

• Celiac Disease
  

  It is very important to avoid wheat glutens and there are plenty of alternatives available on the market.

• Irritable Bowel Syndrome
• Leaky Bowel Syndrome
• Crohns Disease (inflammation of the intestines)
• And many other diseases

However, we understand that in our society it is very hard to completely avoid wheat altogether; wheat has been an American staple. So, we have created a general rule-of-thumb when it comes to eating wheat products: If you are going to consume wheat, make sure it is NOT genetically modified (which usually means organic), look at the nutritional label and if wheat is listed in the first four ingredients, the product should be avoided.  Don’t be fooled by “whole wheat” as this still contains wheat gluten.

*THE STATEMENTS HAVE NOT BEEN EVALUATED OR APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA). THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.

The Robert Fishman Institute is very pleased to announce the addition of two new world-renowned speakers for the “Yes … We Can Think Outside the Box” The Next Generation 2-Day Conference on Functional Medicine. (Please click on the below lecture’s names for a complete biography).

Russell Blaylock, M.D Featured Topic: Nutrition & Behavior

Richard Lord, PhD Featured Topic: The Brain-Gut Connection

As previously announced, New York Times Best Selling Author, Daniel G. Amen, M.D. will be presenting the research and findings of his book: “Change Your Brain, Change Your Body.”

Don’t miss out on the chance to take your practice to the next level … Early registration is going on until September 27^th – take advantage of the $200 in savings now.

Other invited speakers:

• Robert Fishman, P.D.
• Lynn Lafferty, Pharm.D, N.D.
• Steven Joyal, M.D.
• Scott Fogle, N.D.
• Stacey Nottingham, D.C.

Topics will include:

• Fishman Institute Protocol of Bioidentical Hormones
• What to Do When Your Patients Want to Get Off Prescriptions
• The Gut-Brain Connection
• Neurotransmitters: A New Way to Look at Psychiatric Diseases
• Pancreas Fatigue: Predicting and Treating Before Diabetes Begins
• Weight Loss: New Findings on Losing and Keeping it off
• Optimal Sexual Health: Amazing New Findings
• Your Hormones: More Than You Think
• Practical Use of Supplements & Nutrition In Your Practice

Register: Visit www.lef.org/OutsideTheBox • Call 1-866-598-6752 • Fax 1-800-528-8984

Location: Nova Southeastern University Health Professions Division 3200 S. University Dr., Davie, FL (Fort Lauderdale area)

Early Bird Registration Specials (prices good through Sept. 27, 2010): $599 for All Medical Professionals (CME credits available) $149 for Life Extension Members (non-medical                  professionals only)

Full Tuition Registration (prices effective after Sept. 27, 2010): $799 for All Medical Professionals (CME credits available) $199 for Life Extension Members (non-medical professionals        only)

Get Up To Speed: Purchase the 2009 6-Disc DVD Box-Set, complete with all lecturer’s pdf slideshow documents! Cost is $99 plus shipping. Click here to order now.

By Dr Samira Hernandez & Tiffany Ellis

The Folic Acid Molecular Structure

Folic acid is an important nutrient for women who may become pregnant, because a woman’s blood levels of folate fall during pregnancy due to an increased maternal RBC (Red Blood Cell) synthesis in the first half of the pregnancy and fetal demands in the second half.[7] The first four weeks of pregnancy (when most women do not even realize they are pregnant) require folic acid for proper development of the brain, skull, and spinal cord.[8] Folic acid deficiency is linked to neural tube defects, such as spina bifida and anencephaly. In order to prevent these birth defects, it is recommended that all women of childbearing age supplement their diet with folic acid in a dosage of 400 mcg to 800 mcg daily. The greatest benefits of folic acid supplementation are seen within the first 6 weeks of gestation and the three months previous. Therefore, it is imperative that all women of childbearing age take the recommended supplementation of folic acid.

So what exactly is folic acid? Folic Acid, is also known as vitamin B9 [1] or folacin. Folate is the naturally occurring form, as well as pteroyl-L-glutamic acid and pteroyl-L-glutamate, which are forms of the water-soluble vitamin B9. Folic acid is itself not biologically active, but its biological importance is due to tetrahydrofolate and other derivatives after its conversion to dihydrofolic acid in the liver.[2]
Vitamin B9 (folic acid and folate inclusive) is essential to numerous bodily functions ranging from nucleotide biosynthesis to the remethylation of homocysteine. The human body needs folate to synthesize DNA, repair DNA, and methylate DNA as well as to act as a cofactor in biological reactions involving folate.[3] It is especially important during periods of rapid cell division and growth. Children and adults both require folic acid in order to produce healthy red blood cells and prevent anemia.[4]

A 2003 opinion article in the New York Times[6] named micronutrients, especially folic acid, the “world’s most luscious food,” since absence of folic acid and a handful of other micronutrients causes otherwise-preventable deformities and diseases, especially in fetal development. This article suggests that adding folic acid and micronutrients to the food supply of developing countries would have a greater impact than any other single action in improving world health.
Folate and folic acid derive their names from the Latin word folium (which means “leaf”). Leafy vegetables are a principal source of folate, although, in Western diets, fortified cereals and bread may be a larger dietary source, although this is much less nutritious than consuming leafy greens.

Certain foods are very high in folate:
? Leafy vegetables such as spinach, asparagus, turnip greens
? Legumes such as dried or fresh beans, peas and lentils
? Liver and liver products also contain high amounts of folate
? Baker’s yeast
? Fortified grain products (pasta, cereal, bread); some breakfast cereals (ready-to-eat and others) are fortified with 25% to 100% of the recommended dietary allowance (RDA) for folic acid
? Sunflower seeds

Certain foods that have moderate amounts of folate:
? Fruits, such as: orange juice, canned pineapple juice, cantaloupe, honeydew melon, grapefruit juice, banana, raspberry, grapefruit, strawberry
? Vegetables, such as: beets, corn, tomato juice, vegetable juice, broccoli, brussels sprouts, romaine lettuce, bok choy,[8]

A table of selected food sources of folate and folic acid can be found at the USDA National Nutrient Database for Standard Reference.[10] Folic acid is added to grain products in many countries, and, in these countries, fortified products make up a significant source of the population’s folic acid intake.[11] Because of the difference in bioavailability between supplemented folic acid and the different forms of folate found in food, the dietary folate equivalent (DFE) system was established. 1 DFE is defined as 1 µg of dietary folate, or 0.6 µg of folic acid supplement. This is reduced to 0.5 µg of folic acid if the supplement is taken on an empty stomach.[12]

Folic acid naturally found in food is susceptible to high heat and UV, and is soluble in water.[13] It is heat-labile in acidic environments and may also be subject to oxidation.[13]
The risk of toxicity from folic acid is low because folate is a water-soluble vitamin and is regularly removed from the body through urine.[14] The Institute of Medicine has established a tolerable upper intake level (UL) for folate of 1 mg for adult men and women, and a UL of 800 µg for pregnant and lactating (breast-feeding) women less than 18 years of age. Supplemental folic acid should not exceed the UL to prevent folic acid from masking symptoms of vitamin B12 deficiency.[15] A 10,000-patient study at Tufts University in 2007 concluded that excess folic acid worsens the effects of B12 deficiency and in fact may affect the absorption of B12.[16]

A study at the University of Adelaide concluded that the intake of folic acid supplements during late pregnancy increases the risk of babies developing childhood asthma by 30%, although researchers emphasized that their finding did not contradict recommendations to supplement folic acid in first trimester, when no additional risk was found.[17]

References:
[1] ^ Ural, Serdar H. (2008-11). “Folic Acid and Pregnancy.”. Kid’s Health.
[2] ^ a b c d Bailey SW, Ayling JE (September 2009). “The extremely slow and variable activity of dihydrofolate reductase in human liver and its implications for high folic acid intake”. Proceedings of the National Academy of Sciences of the United States of America 106 (36): 15424–9. doi:10.1073/pnas.0902072106. PMID 19706381.
[3] ^ a b c d Weinstein SJ et al Null Association Between Prostate Cancer and Serum Folate, Vitamin B6, Vitamin B12, and Homocysteine Vol 12 pg 1271-1272 Cancer Epidemiology, Biomarkers, & Prevention November 2003
[4] ^ “Dietary Supplement Fact Sheet: Folate.”. Office of Dietary Supplements, National Institutes of Health.
[5] ^ a b Ebbing M, Bønaa KH, Nygård O, et al. (2009). “Cancer incidence and mortality after treatment with folic acid and vitamin B12″. JAMA 302 (19): 2119–26. doi:10.1001/jama.2009.1622.
[6] ^ New York Times World’s Healthiest Foods
[7] ^ a b c Barr, S. FNH 371:Human Nutrition Over the Life Span, course notes. (2009), page 19
[8] ^ a b c http://www.eatrightontario.ca/en/ViewDocument.aspx?id=109
[9]^ [1]
[10] ^ “Reports by Single Nutrients”. USDA. 2009-02-13. Retrieved 2009-03-19.
[11] ^ Dietrich M, Brown CJ & Block G (2005) The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States. J Am Coll Nutr 24, 266-274.
[12] ^ Suitor CW & Bailey LB (2000) Dietary folate equivalents: interpretation and application. J Am Diet Assoc 100, 88-94.
[13] ^ a b [2]
[14] ^ Hathcock JN. (1997). “Vitamins and minerals: efficacy and safety”. American Journal of Clinical Nutrition 66 (2): 427–37. PMID 9250127.
[15] ^ Baggott JE, Morgan SL, HaT, Vaughn WH, Hine RJ (1992). “Inhibition of folate-dependent enzymes by non-steroidal anti-inflammatory drugs”. Biochemical Journal 282 (Pt 1): 197–202. PMID 1540135.
[16] ^ BBC Folic acid ‘hinders malaria drug’ 21 October 2006
[17] ^ Foodproductiondaily
[18] ^ Popular Science Uh-oh: Folic Acid Linked to Rise in Childhood Asthma 4 November 2009

*THE STATEMENTS HAVE NOT BEEN EVALUATED OR APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA). THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.

Breast Cancer Risk Assessment Test

YES OR NO Do you have a family history of Breast Cancer? (Grandmother, Mother, Sister, Aunts)

YES OR NO Do you not have regular bowel movements? Meaning you go less than once daily?

YES OR NO Do you or have you used oral contraceptives or hormone replacement therapy?

YES OR NO Do you have a history of any cyclical issues such as: cyclical breast tenderness, endometriosis, uterine Fibroids, Fibrocystic Breast, PMS / PMDD or have you been diagnosed or told that you were “estrogen dominant”?

YES OR NO Are you diabetic, pre- diabetic, or do you have blood sugar control issues?

YES OR NO Do you regularly consume non-organic dairy products (milk, cheese, yogurt, etc) or non-organic meat or chicken?

YES OR NO Is your body fat over 30%?

YES OR NO Have you had your 2/16 estrogen-ratio evaluated?

If you answered mostly “yes” to the above referenced questions, then your risk for developing an estrogen-sensitive cancer, like breast cancer, is much greater than someone who answers mostly “no.”

For at risk patients, the Robert Fishman Institute recommends the following protocol:

1. Have your health care provider give you an estrogen-ratio evaluation screening. We recommend the Estronex test.
2. Visit a Bio-Identical Hormone Replacement Therapy (BHRT) specialist. This individual will be able to administer comprehensive testing to evaluate your hormone levels and will then begin balancing your body’s cycle using all natural compounds from plant extracts.
3. Start consuming high amounts of cruciferous vegetables like cauliflower, kale, brussel sprouts, broccoli, cabbage, and bok choy (1)
4. Not a vegetable fan? Then you should look for supplements containing both Indole-3-Carbinole (I3C) and Di-Indole-Methane (DIM). We recommend Cruciferus Complete by Standard Process or Meta I3C by Metagenics
5. Increase your body’s alkaline PH level by eating alkaline foods (2), drinking certified alkaline water (3), and/or using supplements that increase alkalinity.

FOOTNOTES:

(1) Wondering how cruciferous vegetables can help you combat cancer? Here’s a great link to the many benefits of the crucifer plant group:
http://lpi.oregonstate.edu/infocenter/foods/cruciferous/

(2) Wondering what foods are alkaline? Here is a great resource: http://www.liferesearchuniversal.com/acid.html

(3) Here at the Robert Fishman Institute, we are currently in the process of reviewing and testing the various alkaline water systems available on the market and will be publishing our results as soon as they are available.

-Dr. Arango

*THE STATEMENTS HAVE NOT BEEN EVALUATED OR APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA). THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.

In this video, Dr. Robert Fishman explains the building blocks of a healthy cell and the disease states that occur when the brain doesn’t have enough essential fatty acids (Omega’s 3, 6 and 9) and cholesterol needed in order to make healthy cells. You will find out how disease states like Autism, ADD, ADHD, bipolar, heart disease, diabetes, infection, viruses and others are all directly related to damaged cell walls. Additionally, he will discuss the all-natural treatment methods he uses to reverse these disease states and help the body start making new, healthy cells once again.

*THE STATEMENTS HAVE NOT BEEN EVALUATED OR APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA). THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.

As a clinical nutritionist and pharmacist, I have been effectively treating osteoporosis in women, and some men, for over 20 years and I have come up with the following conclusions based off of my observations … I call it a theorem, because much like theorems in geometry, I have been able to prove this again and again.

The Robert Fishman Theorem on Osteoporosis:

Everybody on the face of the Earth made bones as they developed as a young child. This means that everyone’s brain knows the process of how to make bones.

When you are a young child, you do the following:

1. Run, jump, play
2. Go out in the sun and obtain healthy levels of Vitamin D
3. Drink milk and consume other dairy products to obtain calcium
4. Drink water and eat vegetables to obtain trace minerals
5. Everyone had a certain amount of progesterone, an essential ingredient needed to make osteoblast, which then makes bone

Women when they reach their 30′s & 40′s, the following behaviors become the norm:

1. Stop exercising because life becomes too busy
2. No more sun exposure without sunscreen because skin cancer fears
3. Stop drinking milk and consuming as much dairy products
4. Drink bottled water, which doesn’t have minerals, and don’t eat enough organic vegetables. Our food supply is inadequate as a source of trace minerals, because the process of mass production doesn’t allow for the development of nutrition in our food supply
5. Women in the late 30′s and early 40′s naturally start losing progesterone, because progesterone is necessary to start making placenta, in order to make babies. At this stage of life, your body is preparing not to make any more babies

So, you’re body is not missing Fosamax, Boniva, Actinel, Foreo or Reclast, because they were never a part of what we were born with. In order to replace bone you’re losing, all you have to do is give the brain the tools it needs to start making bone once again. This process will take 2 years to replace all of your bone, which is — not coincidentally — the same amount of time your body originally took to make bone. Think about it: At age 2, you are already walking upright and steadily, meaning your body took 2 years to make the bone necessary in order to carry out this function.

The treatment process for osteoporosis is as follows:

1. Exercise every day, especially using weights
2. Go in the sun for 30 minutes without sunscreen on your arms -or- consume 5,000 units of Vitamin D3
3. Obtain a source of absorbable calcium and trace minerals. I recommend Osteoapatite or Calcifood for my patients.
4. You will need to raise your progesterone levels PROPERLY by consulting an expert in Bio-Identical Hormone Replacement Therapy.

I welcome any questions, comments or concerns. Please feel free to contact me at askrfi@gmail.com

-Dr. Robert Fishman

*THE STATEMENTS HAVE NOT BEEN EVALUATED OR APPROVED BY THE US FOOD AND DRUG ADMINISTRATION (FDA). THESE PRODUCTS ARE NOT INTENDED TO DIAGNOSE, TREAT, CURE, OR PREVENT ANY DISEASE.

Who knows how Ms. Jones metabolizes estrogen? It’s a shot in the dark for women using Hormone Replacement Therapy (HRT). Dr. Arango weighs in …

There are 6 commonly known estrogen metabolites, but for today’s blog topic, we will look at 3 of the most commonly known metabolites: 2-OH, 4-OH and 16-OH estrogens. Maintaining the proper ratio between these metabolites is essential to protecting the body from estrogen-sensitive cancer. The first metabolite, 2-OH, will protect you from developing an estrogen-sensitive cancer, which can occur in ovarian, cervical, uterine, and breast tissue. Men are not excluded: The 2-OH metabolite is also responsible for protecting the prostate for men. The second and third metabolites do not. In fact these last two metabolites may even promote an unfavorable balance that can lead to a cancerous condition.

I personally fill thousands of prescriptions for compounded hormone replacement medications for women from all over the United States and often wonder how many of them metabolize estrogen in a safe way. Patients and doctors should know the risk factors for developing cancers related to estrogen and can use the Estronex Test by Metametrix Laboratories to monitor estrogen metabolism before and during the use of hormone replacement therapy (HRT). This testing practice should not be discounted if the person is using Bio-Identical Hormone Replacement Therapy either.

For more information and testing, you can visit The Wellness Center at Post Haste Pharmacy or you can check out the Metametrix website:  http://www.metametrix.com/test-menu/profiles/hormones/estronex. Here’s a sample report for a female: Estronex Sample Report

-Dr. Arango

Omega-3 Fatty Acids are essential to maintaining good health, because all of the cells in your body are constructed with Omega-3′s. Most of us do not realize that we actually have an imbalanced ratio of Omega-3, Omega-6 and Omega-9 in our diets. Omega-3 is taken out of our mass food supply, because this essential fatty acid causes food to perish and spoil very quickly. I want to share with you a post from the renowned health expert Dr. Mercola:

Both Mr. Mercola and I agree that sustaining appropriate levels of Omega-3 Fatty Acids are essential to maintaining good health. However, I do dispute Dr. Mercola’s claim that Krill Oil is the only source available for quality Omega-3′s combined with Antioxidants. Here are some other fantastic alternatives on the market:

• Moxxor, which is a combination of New Zealand Greenlip Mussels and Grape Seed Husk extract. This product is backed by extensive and impressive scientific research.
• Life Extension also makes a great product, which is a blend of Norwegian Fish Oil with Sesame Lignans & Olive Fruit Extract.

Both of these products have received “The Robert Fishman Institute Seal of Approval.” Here’s to your health! To learn more about how healthy cell walls click here.

-Dr. Fishman

This past Sunday Dr Hernandez and I attended the 2nd Annual Autism Resource Fair here in Hollywood/Ft Lauderdale.  It was open to the public and offered many different views on autism. They had many vendors offering different therapy options to children on the spectrum. The speakers addressed issues from nutrition, language and behavior analysis. One of the items I found most interesting at the fair, is the Logan Proxtalker. The Logan ProxTalker is an assistive communications device that allows increased independence in communication because it is the first moveable picture communication system that actually talks. If you are interested in learning more, please visit the company’s website at  www.proxtalker.com. The other therapy that I really like is the hyperbaric oxygen therapy ,which was also displayed at the event. Overall, the conference was informative and we look forward to attending again next year.

-Lisa Feiler, R.N