Tips for Avoiding Edema

Edema is characterized by immense swelling as a result of excess fluid that is trapped in the body’s tissues. There are many types of edema. Peripheral Edema occurs in the feet, ankles, legs and hands, while Pedal Edema is more concentrated in the feet. Additionally, Pulmonary Edema develops when the lungs fill up with fluid and Pitting Edema is distinguishable if dimples are left in the skin once it is pressed on.  

Generally speaking, Edema results in shiny and overstretched skin. One with Edema can find that their hands, ankles, feet, and or legs have appeared to double in size over night. This is no doubt an uncomfortable experience, and coupled with numbness, these symptoms can make it difficult to move and or breathe. 

How To Avoid Edema

  • Refrain from sitting for long periods of time. For example, Edema can be brought on from travel or during a particularly long recovery from surgery. If one is prone to swelling, they should be careful to avoid activities that require them to be immobile for a prolonged time period, such as plane flights. Additionally, standing for too long can also cause inflammation. 
  • As salt causes the body to retain water, limiting one’s sodium intake prevents Edema. This often involves a change in diet. Refrain from processed fatty foods and opt for more vitamin rich fruits and vegetables instead.
  • Drink more water.  Drinking less water actually causes swelling. Staying hydrated keeps one’s body from holding on to excess water.
  • Physical therapy and moving regularly through daily exercises can help properly disperse fluid found in the body’s tissues.
  • Elevation and or massage have been found to be beneficial in moving any built up fluid.
  • Utilizing compression socks prevents fluid from collecting in one’s lower extremities.

Treatment Options

Edema is often found during Pregnancy as one produces more fluids to support the developing baby. While this is normal, it should be carefully managed throughout one’s pregnancy. 

Additionally, while there are many things one can do to avoid Edema, it could merely be a symptom of a much more serious underlying disease. For example, those with circulatory problems, heart disease, or kidney failure could be experiencing Edema and require a more in depth treatment plan when it comes to recovering. 

If you feel you are suffering from Edema, you should consult with your doctor immediately. This will help to determine the severity, type, and treatment options best suited for you. It is also possible that the inflammation is a result of an injury, allergic reaction or side effect to a medication. So speak with your primary care physician to decide the best course of action. 

Dr. Stacie Grossfeld is a trained orthopedic surgeon who is double board-certified in orthopedic surgery and sports medicine. If you feel that you are suffering from abnormal swelling, or have symptoms that align with edema, reach out to Dr. Stacie Grossfeld today. You can contact her by using the contact form on her website or by calling 502-212-2663 today!

 

How Long Does it Take to Recover from a Frozen Shoulder?

If you are feeling any pain when moving or using your shoulder, you may be experiencing what is known as a “frozen shoulder” or “adhesive capsulitis.” Pain in the upper most outside of the arm is often followed by stiffness and a steady loss of movement that can limit day to day activities and tasks. 

In the case of a frozen shoulder, movement is limited not only because of the pain experienced but because tissue has hardened around the shoulder capsule causing it to literally be stuck. 

A shoulder’s capsule is basically strong connective tissue that surrounds the joint of your shoulder’s blade socket and rotator cuff tendons. When this joint becomes inflamed, scar tissue forms and hardens making the shoulder stiff.

There are 3 stages of a frozen shoulder:

  • Freezing
  • Frozen
  • Thawing

During the first stage, one feels a gradual amount of pain and limited range of motion. The second stage brings on less pain, but no movement as the shoulder is effectively frozen in place. By stage three, the patient is beginning to regain strength and movement. However, this whole process can be very time consuming. Freezing may take anywhere from 6 to 9 months, and it could remain frozen for an additional 4 to 6 months. Recovery has been known to take as little as 6 months and as many as 2 years or more. 

While there is much debate around the cause of adhesive capsulitis, it has often resulted from prolonged periods of immobilization due to surgery. Injuries that restrict arm movement, such as a torn rotator cuff or bone fracture are also possible culprits.

Treating a Frozen Shoulder

When it comes to treating a frozen shoulder, time and physical therapy are the best healers. Consistent stretching will eventually unlock the shoulder. That being said, anti-inflammatory medicine and steroid cortisone injections can offer short term relief. Both have been known to reduce pain and swelling around the area.  

If these treatment options are not successful, surgery can be preformed to manipulate the scar tissue and capsule so that they are not restricting mobility. This is usually done during stage two, otherwise known as the “frozen” period. The recovery time for frozen shoulder surgery ranges from 6 weeks to 3  months. 

It is possible that a frozen shoulder can reoccur. To ensure you are able to fully regain mobility of your shoulder, those who are experiencing severe stiffness should consult with an orthopedic specialist. An experienced orthopedic physician can demonstrate the proper exercises and set you on the path to a long lasting recovery. 

If your frozen shoulder symptoms persist, contact Dr. Stacie Grossfeld.  With over 25 years of experience in orthopedic medicine, Dr. Grossfeld has extensive knowledge surrounding shoulder injuries and rehabilitation. If you are in the Louisville or Kentuckiana area and are suffering from frozen shoulder, contact Orthopaedic Specialists today at 502-212-2663.

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome occurs when there is consistent and damaging pressure on the rear tibial nerve.

The tibial nerve branches off the sciatic nerve and can be found near the ankle. As this nerve runs through the inside of the ankle in what is called a tarsal tunnel, it is surrounded and bound by bone and tissue. Too much compression of this area can result in a sharp pain or tingling sensation usually felt in the foot or ankle. However, it is possible to feel the effects of this pressure anywhere along the tibial nerve.   

Tarsal Tunnel Syndrome is the equivalent of Carpal Tunnel Syndrome in the foot and ankle.

Common causes of this syndrome include:

  • Flat Feet that stretch the nerve
  • Varicose Veins that surround the nerve
  • Inflammation from Arthritis
  • Inflammation from Diabetes
  • Injuries like Ankle Sprains or Fractures

Treatment Options for Tarsal Tunnel Syndrome

If not treated in a timely manner, Tarsal Tunnel Syndrome can develop into permanent nerve damage affecting the way one walks and participates in normal activities. If you are suffering from sharp pain near or around the ankle, see an orthopedic surgeon immediately to determine the most effective treatment plan for you. 

Anti-inflammatory medications or steroid injections may be recommended to reduce swelling around the nerve. Other conservative corrective measures include rest, ice and elevation. A brace and or arch inserts in your shoes can also help offer support. Additionally, physical therapy may be used to strengthen the muscles around the nerve thus relieving the area of pressure.

Stem Cell Injections for Tarsal Tunnel Syndrome

If pressure in the tarsal tunnel persists, stem cell injections may offer a patient a more effective treatment plan. Stem cell therapy is a natural way to utilize your own body’s growth factors to heal injured tissues. It has been known to be effective in treating arthritis as well as injuries in feet and ankles. 

If your compression stems from arthritis or an injured ankle, stem cell injections could regenerate the inflamed tissues. Stem cell therapy is a safe and painless procedure that only takes one convenient office visit. It is a steroid and drug free way of relieving the pain associated with tarsal tunnel syndrome. A great alternative to surgery, stem cell injections allows patients to quickly return to their normal activities. 

If your symptoms of tarsal tunnel syndrome persist, contact Dr. Stacie Grossfeld. Dr. Grossfeld has over 25 years of experience in orthopedic medicine and is a double board-certified orthopedic surgeon. To get more information about stem cells as a treatment option, or to make an appointment with the Orthopaedic Specialists, call 502-212-2663 today.

Under Pressure: What Causes a Pinched Nerve?

Nerves act as sounding alarms for our bodies, sending messages to alert us of damage done. In the case of a pinched nerve, we often feel sharp pain. This pain is the symptom of nerve compression.

What is a Pinched Nerve?

When a nerve is surrounded by too much compression from nearby tissues such as muscles, tendons, cartilage or bones, it becomes pinched from the pressure. Even the simplest of actions can cause a pinched nerve; whether it be lifting something too heavy or bending at the wrong angle. 

It’s normal if this pain is felt at the site of the compression as well as throughout your body as our nerve paths exist in our back, neck, arms and legs. In addition to pain, one may experience numbness, weakness and a tingling sensation as a result of a pinched nerve. Carpal tunnel syndrome for example, can be caused by a pinched nerve in the wrist; leading to pain and numbness in your fingers and hand.

Causes of a Pinched Nerve

An injury such as a herniated disk can also cause a pinched nerve to occur by putting excessive pressure on the root of the nerve. Being overweight is another condition that can result in a compressed nerve, as well as bone spurs and repetitive physical movements either from sporting activities or labor intensive tasks. Additionally, inflammation from arthritis can even cause tissue to compress nerves in our joints. 

Treating a Pinched Nerve

While a pinched nerve is usually only felt for a short period of time, it can lead to chronic pain and permanent nerve damage if left untreated. Treatment usually includes rest from the activity thought to have caused the tension in the first place as well as physical therapy to relieve the tightness, and stretch and strengthen your muscles for greater flexibility. Steroid injections can also be utilized to reduce any inflammation near the nerve.

Habits like practicing good posture, not staying in the same position for too long, and taking breaks from repetitive physical activity can reduce your chances of experiencing a pinched nerve and over stressing a specific area of your body. 

Surgery may be required if the pressure on the nerve is not relieved. If you or someone you know is suffering from a pinched nerve, one should seek treatment as soon as possible in order to alleviate any pain and prevent the nerve damage from worsening.

If your pinched nerve symptoms persist, contact Dr. Stacie Grossfeld.  With over 25 years of experience in orthopedic medicine, Dr. Grossfeld has extensive knowledge surrounding musculature. If you are suffering from prolonged pinched nerve symptoms, contact Orthopaedic Specialists today at 502-212-2663.

Common Sports Injuries For Kids: Learn More from Louisville Children’s Orthopedic Surgeon Stacie Grossfeld

 

It’s important as parents, coaches and mentors that we encourage kids to live an active healthy life. This naturally includes participation in sports. However, all physical activities come with the risk of injury, especially as kids are prone to tumbles, scrapes, bumps and bruises.

Being prepared for potential sports injuries is critical in that fast and effective treatment can often limit the severity of the injury. That being said, here are 5 of the most common sports injuries for kids and preventative measures you can take to avoid them.

1. Heat Related Illness

Kids can experience dehydration and or heat exhaustion if they are over exerting themselves in particularly hot weather coupled with high humidity. Factors such as body weight and not being accustomed to physical activity in the heat can increase the chances of a heat related illness. Signs include headache, stomach pain, nausea and thirst. All children participating in sports should practice proper hydration to prevent such an event from occurring, 

2. Shoulder Dislocations

Shoulder dislocations happen when the arm is forced backwards and one hears a pop. The result is immense pain and limited movement. To ensure that the shoulder heals properly, only a trained physician should put it back in place. Young athletes tend to be prone to these injuries as their joints are looser. However, physical therapy can help strengthen shoulder muscles and prevent a repeat dislocation.

3. Torn ACL

A brunt force to the outside of the knee or sudden and extreme movement from the athlete themselves can cause a torn ACL. One will often feel a popping or tearing feeling in the knee and have trouble bearing weight. As most ACL tears require surgery, one should consult with an orthopedic surgeon or sports medicine physician as soon as possible.

4. Concussion

There are over 250,000 sports related concussions per year among student athletes. They are most common in contact sports. Symptoms include headaches, slurred speech, mood swings, loss of memory, nausea and vomiting, dizziness, as well as confusion. While concussions are a serious brain injury, they can easily be left undetected. Proper concussion protocol must be followed after an event with head trauma occurs. The only treatment for a concussion is rest from physical activities and electronic devices for a long period of time before returning to play. 

5. Sprains & Strains

Injuries to the hand, wrist and ankle are all too common in active children. Most are the result of a fall. Swelling, pain and lack of movement are sure signs of an injury. However, immediate rest, icing, compression and elevation tend to be most effective for both sprains and strains of any kind. Sprains affect ligaments, while strains impact muscles and tendons. To determine if it is a break or fracture, an X-ray must be preformed and a doctor will decide if a cast or bracing is needed.

It should be noted that over use injuries in one area of the body can be avoided by mixing up the sporting activities a child participates in. Additionally, kids are at more of a risk for injury if they aren’t used to being active as their body is not conditioned for physical activity. 

Dr. Grossfeld has over 25 years of experience in orthopedic medicine and is a double board-certified orthopedic surgeon in sports medicine. To get more information about sports related injuries, contact Dr. Stacie Grossfeld today by calling 502-212-2663 to make an appointment. Orthopaedic Specialists has two convenient locations in Louisville, KY and is currently accepting new patients.

Important Facts About Sports Related Concussions in Female Athletes

There are over 250,000 sports related concussions per year among student athletes. However, the female athlete has been shown to sustain 50% more concussions than the male athlete. The differences are most commonly seen in sports such as basketball, soccer, and volleyball, as well as lacrosse.

Additionally, some studies have documented that female athletes have more severe concussions then their male counterparts. This is often coupled with worse symptoms, including greater cognitive functional deficits as well as a longer recovery period.

Why do females have a higher risk of sustaining a concussion? There have been many medical theories proposed to answer that question…

  1. Females have slender necks and smaller heads compared to males. Biomechanical studies demonstrate that females have 50% more head exhilaration during head trauma than males. This  translates into a higher likelihood of injury to the brain during a traumatic event.
  2. The female athlete has a relatively weak neck musculature compared to males. This may lead to less protection of the head during a major impact.
  3. Hormonal differences could also play a role as estrogen has been shown to be more detrimental to a brain after an injury.
  4. Additionally, there is a theory that the male athlete tends to report concussions less than a female does. There have been reports that gender stereotypes reinforce this behavior as males may try to provide a tougher persona. However, in my experience taking care of the University of Louisville women’s soccer and lacrosse team, I would disagree with this theory.

Dr. Grossfeld has over 25 years of experience in orthopedic medicine and is a double board-certified orthopedic surgeon in sports medicine. To get more information about concussions and other sports related injuries, contact Dr. Stacie Grossfeld today by calling 502-212-2663 to make an appointment. Orthopaedic Specialists has two convenient locations in Louisville, KY and is currently accepting new patients.

Stem Cell Injections for Achilles Tendinitis

What is Achilles Tendinitis? 

Achilles tendinitis is an injury to the Achilles tendon. The Achilles tendon is the largest tendon in the body and runs down the back of the lower leg to connect the calf muscle to the heel bone. While the Achilles tendon is known for its strength and resilient flexibility, it can become inflamed. Bone spurs or sudden repetitive stressed movements can strain the tendon. Once inflamed, basic activities like walking, jumping, or running can be painful. Achilles tendinitis is a common ailment, and swelling as well as severe pain can result in a limited range of motion.

A conservative self care plan often includes rest, ice, anti-inflammatory medication, and or orthopedic shoes. Physical therapy has been known to help as well. Additionally, focusing on low impact sports is likely to help reduce any further stress on the tendon. However, if a patient is still seeing dealing with immense pain, they should consider a more proactive treatment plan. 

Stem Cell Injections as a Treatment Option

Stem cells have been known to revitalize the Achilles tendon and can even encourage the healing of an already surgically repaired tendon. This is because stem cells have over 200 various growth factors with anti-inflammatory effects. These growth factors contain proteins or enzymes that can reduce inflammation and pain.

Stem cell injections offer more than the temporary relief of other drugs. They take advantage of the body’s ability to repair itself by helping the body’s own stem cells reconstruct and regenerate injured tissues causing pain

Before receiving stem cell injections for Achilles tendinitis, an MRI or X Ray are required in order for a doctor to properly diagnose the injury. Stem cell treatments are a popular alternative to surgery as they offer faster relief and a shorter recovery time. They are normally administered during a scheduled office visit, and through a single injection. 

Dr. Grossfeld has over 25 years of experience in orthopedic medicine and is a double board-certified orthopedic surgeon. To get more information about stem cells as a treatment option, call 502-212-2663 to make an appointment today.

 

The Top 8 Things You Can Do To Avoid Knee Replacement Surgery

Knee problems are becoming more and more prevalent for patients of all ages, as old sports injuries rear their ugly head. However, even for those in constant pain, going under  the knife should never be the first option. There are many treatment options that can add longevity to your knees and have been found to be just as effective as surgery.

8 Ways You Can Avoid Knee Replacement Surgery 

  1. Weight loss. For every pound less that you weigh, you will place 3 pounds less of force on your knee joint when you walk.
  2. Physical therapy. When you strengthen the muscles around an arthritic joint, it can help to reduce the force and pain on the joint. There are some exercises that are very hard on an arthritic knee. A physical therapist is a good resource when seeking guidance for the correct exercises.
  3. Anti-inflammatory medicine. An oral anti-inflammatory medication such as ibuprofen or Aleve can be helpful. However, a primary care physician should determine if you are a good candidate before hand. As anybody with a history of renal disease or stomach ulcers cannot take this class of medication.
  4. Unloader knee brace. 90% of people‘s new arthritis is located in the inner part of their knee (also known as the medial compartment). An unloader knee brace can force you to place more weight on the outer half of your knee which typically does not have the same degree of arthritis. This can help to significantly reduce pain from arthritis and theoretically lessen the progression of the arthritis or at least slow it down.
  5. Cortisone injection. Cortisone is a steroid that is known to help reduce inflammation in the inner part of the knee joint. However, it is only temporary and tends to work between 3 to 6 months
  6. Hyaluronic injection. Hyaluronic acid is a natural fluid in your knee joint. When you get arthritis, this fluid becomes very thin and does not provide a cushion to the knee. Injecting a synthetic hyaluronic acid tricks the knee joint into producing a more normal fluid for about 6 to 12 months. This can help reduce knee pain for that duration of time in an arthritic knee.
  7. PRP injection. PRP stands for platelet rich plasma. Platelets have a significant amount of growth factors. Blood is drawn from your arm, centrifuged, and then platelets are injected back into the knee joint. This can give you up to 12–24 months of pain relief in an arthritic knee.
  8. Stem cell recruitment therapy. Stem cell injections are the only true treatment option that can help to improve the health of a knee joint. It is the first treatment modality that can actually reverse or slow down the arthritic process.

If you are suffering from joint pain due to inflammation, arthritis, or an injury — contact Dr. Stacie Grossfeld today by calling 502-212-2663. Dr. Stacie Grossfeld is an orthopedic surgeon in Louisville, KY who is double board-certified in orthopedics and sports medicine. She has over 20 years of experience in orthopedics and is always looking for new treatment methods to bring to her clientele. Orthopaedic Specialists has two convenient locations in Louisville, KY and is currently accepting new patients.

Are You a Candidate for Subchondroplasty?

When your bones experience continuous wear and tear, they can develop stress fractures or bone marrow edema (also referred to as bone bruises or chronic bone marrow lesions). This is quite common in older adults; specifically women and can cause pain as well as physical limitations.

A new joint preserving procedure called Subchondroplasty, provided by a board certified orthopedic surgeon like Dr. Stacie Grossfeld, may be able to relieve a patient’s pain and restore joint function. Subchondroplasty entails an injection of a hard-setting bone substitute that mimics the chemical structure of an actual human bone. Once injected into the bone, it works to seal up a fracture and over time can even be resorbed and replaced with new bone. Subchondroplasty is a minimally invasive treatment and oftentimes spurs bone growth resulting in a healed bone and reduced pain in the leg, knee or hip.

Are you a Candidate for Subchondroplasty?

If you have suffered from chronic and severe bone pain for at least 3 months and have trouble walking or standing, you could benefit from Subchondroplasty. If other injections, anti-inflammatory or pain medications, knee braces, crutches, physical therapy, and or rest have not worked, Subchondroplasty could be the right treatment. Additionally, patients with cartilage loss and bone deterioration associated with osteoarthritis, as well as those diagnosed with arthritis or osteoporosis are usually good candidates for the procedure.

An MRI is first required to determine if you have bone marrow edema, as spots can be seen in the bone that represent swelling or bone damage. A relatively healthy body weight and or lifestyle changes are suggested for potential patients receiving this treatment in order to prevent reoccurring problems that could require further treatments.

Subchondroplasty is a popular choice for patients who enjoy living an active life and want to avoid a bone replacement. It is an outpatient procedure, usually lasting 20 minutes. While it depends on the patient, most can bear weight immediately after treatment is complete. 

If you or someone you know is experiencing pain due to insufficiency fractures or bone marrow edema, contact Dr. Stacie Grossfeld at Orthopaedic Specialists. Dr. Grossfeld has been performing subchondroplasty for about two years and has had excellent results. For more information and to schedule an appointment with Louisville orthopedic Dr. Stacie Grossfeld, call 502-212-2663. You can also visit either of the Orthopaedic Specialists’ locations in Louisville, KY to get more information and schedule an appointment today.

Pitting Edema VS Non-Pitting Edema: What’s the Difference?

pitting edemaEdema is a medical terms that refers to swelling caused by the body holding onto fluid. Edema, which was once called dropsy, usually occurs in a person’s feet, ankles, or legs. There are some occasions where edema can also occur in a person’s hands, face, or even affect additional body parts. There are many different kinds of edema and the causes can vary from diagnosis to diagnosis. Edema is often a symptom of another, more serious, condition and should be treated by a medical doctor. Two common forms of edema are pitting edema and non-pitting edema. These are the most common classifications of edema and are easily identifiable.

The biggest difference between pitting and non-pitting edema is the way the two conditions respond to pressure. Pitting edema responds to pressure, be it from a finger or a hand, while pitting edema does not. If you press on your skin with your finger and it leaves an indentation, you could be suffering from pitting edema. Non-pitting edema, on the other hand, does not respond to pressure or cause any sort of indentation. Follow along to learn more about pitting and non-pitting edema including causes, treatments, and more information.

Pitting Edema

Pitting edema often affects areas of the lower body including the feet, legs, and ankles, but can occur anywhere on the body. This condition is often a local problem that involves the veins, but can also be a problem within one of your body’s systems of organs. Pitting edema can be a result of problems with the liver, kidneys, heart, or even the lymphatic system. Regardless of where the pitting edema is occurring, it is a sign that your body is holding onto fluid or fluid is not being carried away as it should. If these symptoms apply to you, you should seek medical help immediately.

While pitting edema can usually be associated to a problem with the liver, kidneys, heart, or lymphatic system, there are many other causes that can result in pitting edema. Some of those various issues include:

  • Lung Diseases
  • Obesity
  • Pregnancy
  • Medications
  • Low Levels of Protein
  • Heart Failure

Some of these medical conditions are not cause for concern. Pitting edema in pregnancy is more common than not; however, it can still be a cause for concern and should be mentioned to your doctor. Certain medications that result in pitting edema should be reassessed by the prescribing doctor. Risk factors that are associated with pitting edema include: high sodium intake, emphysema, immobility, sedentary lifestyle, and more.

Diagnosis for pitting edema is somewhat difficult since a list of telltale signs for diagnosing this medical issue does not exist. However, through a set of tests and an extensive evaluation that may include a chest x-ray, blood work, and a heart echo can help a physician identify pitting edema. If you are diagnosed with pitting edema, there are a wide variety of treatments available. Some treatments can be applied at home while others must be performed by a practicing physician.

Non-Pitting Edema

Non-pitting edema is similar to pitting edema save for the indentation (or “pit”) that remains visible after pressure is applied in a case of pitting edema. Unlike pitting edema, non-pitting edema is much easier to diagnose because it is caused by three very specific conditions: lymphedema, myxedema, and lipedema.

Lymphedema

When it is extremely difficult for lymph fluid to drain as it should, it is often due to a blockage. This condition is called lymphedema. Some people are born with this condition while others develop it. Those who develop lymphedema often develop it after surgery or as a secondary condition to a bigger issue. When this lymph fluid cannot drain, it gathers and swelling results.

Myxedema

Another condition that can be linked to pitting edema is myxedema. Myxedema can be identified by severe swelling in the legs and feet, but swollen eyelids and lips are also symptoms. Tongue swelling is another symptom of myxedema though it is not as common as the swelling observed in other areas of the body. Most people who suffer from myxedema suffer from hypothyroidism – both severe and advanced cases.

Lipedema

Lipedema is another condition that results in non-pitting edema. When fat cells grow at an increased rate, they tend to retain more fluid. This results in a painful case of non-pitting edema that occurs in women, almost exclusively.

These three causes of non-pitting edema can be diagnosed by unusual swelling. Once a doctor identifies unusual swelling, they will review medical records and do a wide variety of tests to diagnose. Among the three medical conditions, lipedema is the hardest to diagnose and requires a physical examination. During the exam, doctors will look for: tender skin, excessive weight, and bruising. Once non-pitting edema is diagnosed, depending on the condition associated with it, the treatment plans vary and are determined by a trained physician.

Dr. Stacie Grossfeld is a trained orthopedic surgeon who is double board-certified in orthopedic surgery and sports medicine. If you feel that you are suffering from abnormal swelling, or have symptoms that align with pitting edema, reach out to Dr. Stacie Grossfeld today. You can contact her by using the contact form on her website or by calling 502-212-2663 today!