Dr. Rodolfo Gari of Florida Pain Relief Group Talks Chronic Pain and How It Can Be Treated

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Interviewer: We hear the term chronic pain all too often. It’s a common problem, but what exactly is it? Dr. Rudy Gari from Florida Pain Relief Group joins us now to help. Dr. Gari, good to have you here.

Dr. Gari: My pleasure.

Interviewer: And unfortunately, over a billion people worldwide have chronic pain. So what exactly does that mean?

Dr. Gari: So chronic pain refers to pain that continues when it should have been gone. So for example, you sustain an injury and we know typically, the pain from that injury should be gone in about two weeks or more or less, whatever that might be. Well, maybe it’s three weeks, four weeks, and it lasts longer. That pain now becomes chronic and there are actually some patients that they’ve had pains for so long, so many months, so many years, where the pain, in and of itself, now becomes a disease. So now, you have an illness which is pain. Pain should be a symptom not an illness.

Interviewer: And that becomes their norm. That’s their everyday life.

Dr. Gari: That becomes their norm. It becomes…

Interviewer: They forget what feeling good feels like.

Dr. Gari: Sometimes you have patients that, you know, that are in chronic pain for years and it no different than if you have diabetes of high blood pressure.

Interviewer: Okay. So you see people like these I’m sure every day.

Dr. Gari: Every single day.

Interviewer: So what can you do for somebody who comes in and says, “Like I’ve had this pain for a lot longer than two weeks.”

Dr. Gari: So the first thing that we wanna do is we wanna cure that. So you know the field that I’m in is called Pain Management. I’d love it if it could be called Pain Curer. There are many things we can cure pain but unfortunately a lot of times, we have to find ways to get patients to live their life again through different means. So the first thing we wanna do is we wanna make sure, is this something that we can cure? So we have to make a diagnosis. We have to be physicians, we have to listen to that patient, look at all the medical records, perform an examination in the laboratory, whatever it takes. And there are actually some chronic pain that we have been able to successfully treat where it goes away.

Interviewer: I know a lot of people are on some kind of pain pill, opiates and I’m sure there are some doctors out there who say, “This is the only thing that’s going to help you cut through this pain.” You don’t believe that, right?

Dr. Gari: No. I don’t believe that. There are patients that are gonna need opioids, there’s no question about it. But if we can take that patient and instead of that patient taking 100 milligrams of morphine or, you know, per day, if we can reduce that to 30 milligrams a day, a two-thirds reduction in the amount of medication that you need to function, that is a significant and major improvement and we do that through different ways.

Interviewer: Well, we hear people overdosing on pain pills every single day. So obviously cutting back as much as possible is what you’re trying to aim for here. So let’s talk about different ways to manage pain. If it’s not popping a pill, what other things can you do?

Dr. Gari: So we have a tremendous toolbox for taking care of someone’s pain other than pain pills. A lot things that we do… So if you think about pain, pain is mediated by nerves. So there’s a thing called nerve blocks. We do a lot of those and because we wanna stop the pain transmission before you can feel that pain. So different types of nerve blocks, they are just typical injections done outpatient procedures. We give sedatives to relax you. Do those nerve blocks and we’ve had much success. I’ve been doing this for over 25 years, and we can help those patients by those types of nerve blocks where their pain drops from a very high level to a very low level and take a lot less pain medication than they were taking before.

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Dr. Rodolfo Gari of Florida Pain Relief Group Talks How Failed Back Surgery Syndrome Works

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Cyndi: Anyone who suffers from chronic back pain knows they’ll try anything to get relief. Well, sometimes that means undergoing surgery. But what if that doesn’t actually work? Failed back surgery syndrome can sometimes be a result, and avoiding surgery is an important measure to stamping out FBSS. Dr. Rudy Gari is here from Florida Pain Relief Group to talk more about this, FBSS, Failed Back Surgery Syndrome.

Dr. Gari: Yes.

Cyndi: Okay. How common is it to see this?

Dr. Gari: It’s very common. So we have great neurosurgeons, they do fantastic work, but unfortunately, you know, it’s not 100%. And so we have some patients that, despite a great surgical procedure, the patient continues to have back pain afterwards. So we actually get a lot of referrals from our surgeons when they’ve done everything possible that they can and they still have that back pain.

Cyndi: Are there certain people, in particular, that are more prone to this?

Dr. Gari: That can really happen to just about anybody. The more surgeries that you have, it makes more sense, the more likely that you are… Because the first surgery has a high success rate, the second one is less, and the third one’s even less. So yes, our surgeons do everything that they can, but unfortunately there are some patients that, despite that, they still continue with pain. And that’s where we come in and we can help out.

Cyndi: I imagine, after going through all that, these patients that are coming to you are at their wit’s end because they’ve tried. They’ve gone through major surgery, and they still have pain. So what can you do for them?

Dr. Gari: Sure. So we can do a lot of things for ’em. The first thing we do is perform a thorough history and physical examination and see what’s going on, make sure there’s nothing else that we can do from a surgical point of view. After that, that’s medications. We can do nerve blocks, physical therapy, spinal cord stimulation, stem cell therapy. There’s a lot of different tools that we can have, and we learn more and more every day. It can be pretty debilitating. I’ve had some patients say, “Doc, I just wanna be able to go to the mall and go shopping. I mean, things that we take for granted, they can’t do that. But we can help them, and sometimes that’s a success, is different treatments to allow you to go shopping, to go do grocery shopping, you know, those kind of things.

Cyndi: Does it require a lot of visits to you to get this relief, or is it something that takes time because everyone wants it fixed, you know, yesterday? But obviously you have to assess what the matter is first and then start with the treatment. But is it ongoing treatment usually, or is it a treatment that’s one time and then you’re good?

Dr. Gari: It’s both. So we have some patients that all that they need is, perhaps, you know, two or three nerve blocks and physical therapy and then they’re good. And then, if they aggravate their back again, they come see us. We have other patients where, you know, they just have a lot of damage. They have a lot of scar tissue and different things where they do require more visits from us.

Cyndi: I hear a lot about people who have pain due to scar tissue. Why does that cause so much pain?

Dr. Gari: So what happens is that a scar can form around the nerve, so that nerve is constantly being squeezed. We actually have a procedure that’s called epidurolysis, and what that does is, is that we can actually go in and try to remove, if not loosen up, that scar tissue. And we do that without surgery. We do it through a needle and then a little bit of a catheter. We can go in there and try to loosen that scar tissue.

Cyndi: And that relieves that nerve.

Dr. Gari: Yes.

Cyndi: Ah, and stops the pinching.

Dr. Gari: It’s that squeezing on the nerves by the scar tissue that is formed around it.

Cyndi: Oh, sounds like some really good advice and good news for a lot of people that are out there right now that are going through this because they may think there’s nowhere else to turn. But there is, definitely.

Dr. Gari: Yes, there is.

Cyndi: Thank you, Dr. Gari. Florida Pain Relief Group even offers a same day appointment, so you can visit their website. It is floridapainreliefgroup.com, or give them a call right now, 844-KICK-PAIN. Dr. Rudy Gari, thanks again.

Dr. Gari: My pleasure.

Cyndi: We’ll be right back.

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Dr. Abraham Rivera of Florida Pain Relief Group Talks Best Ways to Handle Foot Pain

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Interviewer: Not many body parts get beat up as much as our feet. Bone spurs, bunions, gout, none of this sounds pleasant. Dr. Abraham Rivera from Florida Pain Relief Group joins us now with ways we can fix these problems, and more. Dr. Rivera, good to have you back on Daytime.

Dr. Rivera: Thank you.

Interviewer: I’m happy to say I’ve never had a bone spur, but I’ve heard they’re horrible. Tell us what exactly is a bone spur and how can you help somebody fix that.

Dr. Rivera: The foot is a very complicated structure. It works, at the end of the day, like a bow and arrow. You have a surface that is made out of a tendon, which would be tantamount to the string on the bow and arrow. And you have bones that are bent, and the string keeps them bent. The places where the string attaches to the bones can grow bone spurs, and those can be very painful, especially when you put traction on that string, on that plantar fascia, which is the bottom of the foot.

Interviewer: What happened? Did the string let go or something? Is that why the bone spurs?

Dr. Rivera: The string is awfully hard so it doesn’t let go, but the string is constantly pulling on those bones. It’s kind of like you have a rope glued to a piece of drywall and you keep pulling on it. Eventually, the drywall kind of sticks out and protrudes out. That’s what happened. The bone spur grows out of the bone, literally. It causes pain every time you press on it and so forth.

Interviewer: What can you do to help somebody that has that?

Dr. Rivera: The first step, as I always tell my patients, is prevention. How’d you get here in the first place? Shoe wear.

Interviewer: Shoes, yeah. Bad shoes?

Dr. Rivera: I hate to tell you.

Interviewer: You’re looking down at my feet right now.

Dr. Rivera: You know, those things were not meant for walking around.

Interviewer: They’re not meant for human beings at all. They really aren’t.

Dr. Rivera: Correct, correct. They’re meant for TV anchors.

Interviewer: Exactly. And since you’re sitting, you’re fine.

Dr. Rivera: Adequate shoe wear. You have to have adequate arch support. And there’s a whole industry built around these things, from arch supports to orthopedic shoes. Truthfully, at the end of the day, go see your cobbler. It’ll cost you very little, and he will make you an arch support that really works in just about all the shoe wear you have, and get you the comfortable shoes that you really should be wearing.

Interviewer: Should be, definitely. Put vanity aside. Let’s talk about bunions.

Dr. Rivera: That is [inaudible 00:02:14].

Interviewer: Is that just because of shoes, or are some people predisposed to have bunions?

Dr. Rivera: Both of them are true. The first thing is ,yes, some people are more predisposed than others. But if you want to get one, buy pointy shoes. Absolutely, guarantee that will get you there.

Interviewer: So, you keep crunching those toes together, it causes the bone to stick out.

Dr. Rivera: Correct. It will. There’s only one way that can possibly happen, it’s pointy shoes.

Interviewer: Is there a topical cream that can help that, or do you need to have surgery to get that shaved down?

Dr. Rivera: Actually, you’d be surprised. Many times, again, by changing the shoe wear, taking the proper care of your feet, many of these things do not need surgery. Topical creams can be part of it, anti-inflammatory medication can be part of it, or we sometimes can inject the joints themselves.

Interviewer: What about gout? Because that’s really painful.

Dr. Rivera: Whole different monster. Now you’re dealing with a metabolic disease in which a patient doesn’t process well a substance called uric acid. This substance dissolves very poorly in the liquid of the joints. And for some reason, it prefers that big toe joint. When it does that, it becomes exquisitely painful. Patients describe to me that the sheets on their bed touching their feet drives them crazy.

Interviewer: Can you give people relief from that?

Dr. Rivera: Yes. We give them medications that decreases the amount of uric acid. Also, we can inject the joints to alleviate the acute pain. But finally, at the end of the day, we need to address the metabolic issue, the, “Why is it that this person is making so much uric acid?” Believe it or not, staying away from the food that contains that is cardinal on it. These people have to be on a diet.

Interviewer: There is relief out there. Dr. Rivera, thank you very much. You can even schedule a same-day appointment. Visit their website. It is floridapainreliefgroup.com. Or give them a call at (844) KICK-PAIN. Get relief today. Thank you again, doc.

Dr. Rivera: You’re welcome.

Interviewer: We’ll be right back.

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Dr. Abraham Rivera Discusses Migraine

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Congratulations to Abraham Rivera, MD, Chief Medical Officer of Physician Partners of America, for appearing in the June/July issue of Pain-Free Living magazine. His article is “Diagnosis: Migraine: How to recognize the differences between tension headaches and even more serious migraines.”

Download article here or pick up on newsstands now!

Pain Free Living June-July 2017 Article by Dr Rivera

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The Link Between Pain and Depression

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Pain and depression are closely linked. Studies show that pain can cause depression and depression can cause pain. Since pain and depression are so closely related, it is important to understand how they work so you can get the treatment you need.

The Ongoing Cycle of Pain and Depression

One of the most frustrating elements for people going through pain or depression is the way that it can quickly lead to a back and forth pattern. It can be a difficult cycle at times, as the more depressed you are, the worse your pain may feel. Then the increased pain can cause you to feel more depressed.

People who have been diagnosed with depression often have an increased chance of developing chronic pain. Similarly, people who have chronic pain can also have a higher chance of developing depression.

What Kind of Pain Could Lead to Depression?

Almost any kind of pain could lead you to have feelings of depression. It could be pain from a recent injury or due to a condition like diabetes or heart disease.

Chronic pain is a major factor in potentially developing depression. Ongoing pain can increase a person’s chance of developing anxiety or depression over time, sometimes leading to clinical depression.

What Causes the Pain and Depression Link?

Researchers believe that the brain is the key to the connection between pain and depression. The structure of the brain is set up so there is some crossover between the areas of the brain where pain takes place and the parts that depression and other mood disorders occur.

Your brain function is another reason why pain and depression may be linked. Your brain uses neurotransmitters to signal pain in your body. Those neurotransmitters also help keep your mood steady using things like norepinephrine and serotonin.

Basically, the same elements that are used to help people with mood disorders can also help to relieve pain, due to the similarities in the brain. That is helpful for treatment, as improving one area can help with the other area as well.

How to Treat Pain and Depression

Whether you have pain, depression or both, there are plenty of treatment options to help you feel better and keep you from getting into the pain and depression cycle. Your doctor can help you figure out the best treatment option.

Possible treatments may include:

  • Psychological counseling- Talking to a professional can be helpful for relieving mood disorders and pain problems
  • Antidepressant medications-  Even though antidepressants are made to help with your depression, they may also help with pain
  • Wellness strategies- Having good overall health can help with your depression and pain, so healthy eating, getting exercise and sleeping well can help
  • Keep stress levels low- Do whatever you can to keep your stress low, like meditation

The cycle of pain and depression can be stopped with the right help. Talk to a medical professional about your symptoms, start treatment and get on the path to feeling good inside and out.

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The Facts About Complex Regional Pain Syndrome (CRPS)

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Complex Regional Pain Syndrome (CRPS) is a nervous system malfunction that you may not have heard of unless you or someone you know has been diagnosed with it. CRPS is a chronic condition where a person feels pain in one or more of their limbs after an injury.

If you have recently had an injury and find that you are having pain in one or more of your limbs, check to make sure it is not CRPS. After a CRPS diagnosis, you probably want to get as much information as you can about the condition. Here are the facts about CRPS:

CRPS Usually Affects the Arms or Legs After Injury or Incident

Your arms and legs are the typical areas that CRPS could impact. It most often occurs after an injury or incident like stroke, heart attack or surgical procedure.

You Should Begin Treatment as Early as You Can

If you are able to begin treatment as early as possible, it will increase your chances of effectively treating it into possible remission. Pay attention to your symptoms and do not ignore the signs of CRPS.

As soon as you recognize CRPS symptoms, get help right away. A specialist can help you manage the symptoms, relieve the pain and keep the condition from getting worse.

Symptoms of CRPS

The symptoms of CRPS may include:

  • Constant feeling of burning or throbbing in the affected limb, typically your leg, arm, foot or hand
  • Swelling in the affected limb
  • The limb may be sensitive to old temperatures or being touched
  • Your limb may change temperature from hot to cold and back
  • Your joints may swell or feel stiff
  • Your skin tone may change, turning mottled or shades of red or blue
  • You skin may also have texture changes, becoming thinner, more tender or shiny
  • The affected limb may have changes in nail and hair growth
  • You may experience muscle spasms or atrophy
  • Difficulty moving the affected limb

These symptoms can vary from one person to the next, but the sensitivity and pain may occur first. The important thing is to see a doctor as soon as you can.

Critical Information About CRPS

One of the reasons why it is so important to pay attention to the symptoms is because the changes in skin color may occur at a point when your condition has become irreversible. Again, prompt treatment is crucial.

It is possible for CRPS to go away on its own if the pain and symptoms are not too severe and do not get worse. However, CRPS could possibly spread from the affected limb to another part of your body, like the limb on the opposite side.

Keep in mind that CRPS pain could get worse if you are stressed out. So even if the condition has you feeling stressed, try to stay calm and simply get the help you need.

Your medical team can help you find the right treatment plan and get your CRPS symptoms under control before they get worse.

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The Psychological Effects of Living with Pain

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Millions of people in the United States have experienced chronic pain and it can have a major impact on your psyche. While you are dealing with chronic pain, it is also important to pay attention to your mental health to assure that you stay healthy in every way.

Pain and your mood are closely related, which is why chronic pain can have a number of psychological effects, including:

Psychological Effects on Your Mood

It can be difficult to be in a good mood when you are going through chronic pain. When you are in pain, it can lead to feelings of depression or anxiety. Those feelings of depression can also lead to your pain getting worse, which can increase your depression all over again.

The psychological effects of chronic pain can cause bouts of anxiety or depression, but it can also lead to long-term clinical depression, which can really impact your quality of life.

Psychological Effects on Your Quality of Life

When you get into that sort of cycle from pain to depression and back, it can end up having an impact on your entire quality of life. It may be difficult to have a positive quality of life when you are facing an increased amount of pain and emotional distress.

Another way that chronic pain can impact your quality of life is by making it difficult for you to do your usual daily activities. When you are in constant pain, it could make it hard for you to go to work, spend time with friends and enjoy your life.

If chronic pain leaves you unable to work, it can make your anxiety or depression feel worse and make you feel stressed out about money. Your quality of life can suffer under these conditions, which is why it is important to get help.

Some of the other ways that chronic pain can impact your quality of life include:

  • Changes in mood including anger, fear, confusion and irritability
  • Anxiety and stress
  • Self-esteem issues
  • Decreased interest in sex
  • Changes in weight
  • Sleep issues and feelings of fatigue

If chronic pain is making you depressed or negatively impacting your way of life, take steps to get treatment as soon as you can.

Getting Help with the Psychological Effects of Living with Pain

Your mental health is very important for your overall well being and quality of life. Chronic pain can be debilitating in a number of ways, from the physical side of the pain to the draining emotional side of the pain.

If you or a family member are suffering through chronic pain and the psychological effects of it, professional help can make a major difference.

Pain management specialists can help you figure out a treatment plan that improves the physical and mental sides of chronic pain. A psychologist may be able to help you through it as well, as therapy can be beneficial for pain management.

With the link between pain and depression, your psychological wellness may need help if you are experiencing chronic pain. Talk to your pain management team and figure out a total wellness plan to feel better.

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Should I See a Pain Management Specialist?

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Chronic pain is exactly what it sounds like. It is an ongoing period of discomfort that causes people to feel almost constant pain in some part of their bodies.

For people who suffer from chronic pain, it can be difficult to lead a normal life. A pain management specialist can help with that.

Before you decide whether or not to see a pain management specialist, here are some things to consider:

Start with Some Questions

Before you see a pain management specialist, ask yourself a few questions first. To begin, how long have you had this pain? If it’s a new pain, you may not need a pain management specialist right away. If it’s something that has been ongoing, you may.

Another thing to ask yourself is if you know what’s causing the pain and if any treatment has improved your discomfort. For example, if you’ve recently been injured and are currently having treatment, you may want to give that treatment time before exploring other options.

However, the big question you should ask yourself is if the pain you’re in is negatively impacting your daily life. If your current treatments aren’t working and your pain makes it difficult to lead a normal life, a pain management specialist may be able to help.

How a Pain Management Specialist can Help

Pain management specialists will work to diagnose it and determine what the causes may be. Since they focus specifically on pain, they know the latest medical treatments and techniques to help.

When it comes to treatment, pain management specialists can come up with a plan to treat your pain using multiple disciplines. This means seeking out other professionals in areas like mental health, rehabilitation, and physical therapy.

Your pain management specialist can help to figure out a comprehensive plan to treat your pain, even when it comes to bringing others onboard.

What Happens When You Visit a Pain Management Specialist?

When you are ready to head to a pain management specialist, come prepared with information. Your specialist will need to know what tests you’ve had done, what medications you’ve taken and what procedures you’ve have done. They may have you fill out a questionnaire before you come in for a visit so they have the information they need.

If you’ve had any imaging done, like X-rays, CAT scans or MRI, be sure to bring copies of the images for your pain management specialist. All of this data will help to get you on the right path from your first visit.

Expect a physical and a question and answer session during your initial visit. If you need any tests done, your pain management specialist will let you know. Ideally, you should ask if any tests are expected when you are scheduling your first appointment so you can plan accordingly. Depending on the test, you might need to fast beforehand or have someone drive you home after.

Ongoing pain doesn’t have to be a mystery. Let a pain management specialist help you find answers and get your life back.

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The Facts About Cluster Headaches

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Headaches are a common ailment, but they can be quite debilitating. A bad headache can make it hard to do your job, drive your kids around or simply get through your day.

If one headache can cause such a disruption, a series of them can be even more difficult to deal with. If you get intense headaches that seem to come in a pattern, you may be dealing with cluster headaches.

What are Cluster Headaches?

Cluster headaches are recurring headaches that may come around each day on a weekly or even monthly basis. The pain of the headaches is often intense and may occur on one side of your head or near one of your eyes.

How Often do Cluster Headaches Occur?

The frequency of cluster headaches may vary. The clusters may hit for only a week or may continue for months. When the clusters pass, you may have months or possibly years of peace before they return.

Some people may experience cluster headaches on a seasonal basis, so it can be easy to mistake them for allergy-relatedheadaches if you are unfamiliar with them.

While the cluster period is going on, the headaches tend to take place each day, sometimes more than once a day. The headaches frequently happen at the same time of the day, often at night when you are in bed.

What are the Symptoms of Cluster Headaches?

Here are some of the symptoms that may accompany cluster headaches:

  • Intense pain, typically located near one eye, though they could impact other parts of your head, face, shoulders or neck
  • Teary eyes
  • Droopy eyelid
  • Red eyes on the side of a headache
  • Swollen eyes on the side of a headache
  • Feeling restless
  • Runny or stuffy nose
  • Flushed or pale face
  • Some sweating

What Causes Cluster Headaches?

Though the exact cause of cluster headaches is unknown, the nerves near your eye are believed to be a factor. That is why the pain is sometimes located near your eyes.

Men may be more likely to get these headaches. Though they may occur at any age, people usually get them between 20 and 50 years old.

Can Cluster Headaches Switch Sides?

Yes, it is possible for headaches to switch from one side of your head to another, though they tend to take place on one side most of the time.

What Happens After the Cluster Headaches Pass?

The pain may pass as quickly as it began. Though the pain should go away, it may leave you feeling really tired. These headaches can be an exhausting experience.

How are Cluster Headaches Treated?

Unless you plan on waiting until the cluster headaches pass, you should go to the doctor for treatment options. There are a number of possible treatments, from oxygen or local anesthetics to dihydroergotamine or triptans.

If you frequently suffer from headaches, your doctor can also help you with a preventative treatment option to help keep the headaches at bay.

Surgery is sometimes an option in extreme situations if other treatments are not working, though this is rare.

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The Hidden Costs of Dealing with Pain

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Pain management impacts millions of Americans each year and costs the national economy billions of dollars. This is because chronic pain costs more than just the cost of medical care.

The hidden costs of chronic pain can impact the economy of the entire country because it has such massive impacts on individuals. If you or someone in your family is going through ongoing pain, here are some of the hidden costs that you may experience:

Difficulty Working

For someone going through chronic pain problems, working can be very difficult, no matter what you do for a living. If you work in job where you have to sit most of the day, you could aggravate your pain. If you work a very physical job, that could also make pain more intense.

Depending on the source of your pain, it could be difficult to concentrate at work and perform your best. Headaches, for example, can be very hard to ignore when you are trying to work.

These difficulties can lead to serious costs. If your pain causes you to need to miss work and take sick days, that can cost both you and your company money. If the pain continues to get negatively impact your work, you run the risk of losing your job, which can lead to a number of monetary issues.

Potential Disability

Pain problems are the leading cause of disability for American adults, according to the American Chronic Pain Association. When pain reaches the point of becoming a disability, there can be a number of potential costs that come along, both for the individual and society.

If a pain-related disability leaves you unable to work, costs can quickly begin to add up. Not only will you need to pay for your medical expenses, but all of the other areas of your life as well. Even if you are able to collect disability, you are likely to have to keep costs down to make it all work out.

Trouble Enjoying Activities

Though the financial costs of chronic pain can be numerous, perhaps the most debilitating cost of all is the personal cost. When you are constantly in pain, it can make it difficult to enjoy your family, friends and hobbies.

There is no dollar amount that can make up for missing memories because you are in pain. You deserve to enjoy your life without the constant struggle of pain holding you back.

Invest in the Right Medical Treatment

With all of the costs that chronic pain can bring about, it can be overwhelming. However, your focus should be on getting better. Though there are costs associated with chronic pain treatment, getting help now can help lessen the expenses you will pay down the road.

Putting off medical treatment is not a good idea. Consider the costs of medical care as an investment in your future. You want to get your pain under control so it does not impact your ability to earn income or enjoy your life.
If you wait to get help, the pain may get worse. Treatment now can actually save you money later.

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