Download complementary and alternative therapies

COMPLEMENTARY AND ALTERNATIVE THERAPIES
I.
OVERVIEW—With the rise of modern pharmaceuticals in the U.S., the use of herbal therapy,
once the staple remedy for common and not-so-common ailments dwindled. Times have obviously
changed. Modern pharmaceuticals continue to thrive, but herbal-products have re-emerged, as
have other forms of complementary and alternative medicine (CAM). Surveys estimate that some
60 million Americans now use some form of CAM--from Gingko biloba (10.8 million) to St.
John’s wort (7.5 million). Today, nearly one-third of the population has tried an herbal product,
and $3.5 billion was spent on herbs in 1997 alone. Acupuncture has become an accepted
alternative for the treatment of chronic pain syndromes as well as other medical uses. Magnet
therapy is being extensively studied as it relates to the treatment an relief of painful diabetic
neuropathy. Pharmaceutical “food” are fast becoming staple items however only a few have been
approved by the FDA as having actual therapeutic benefits.
II.
SOME QUESTIONS concerning herbal remedies
A. Are herbs really effective for treating disease?
1.
2.
The German Commission E has been investigating the usefulness and safety of herbal
remedies since 1978; approximately two-thirds of the 300 tested thus far have been found
to be safe and effective
Asian history, Native American history, Egyptian remedies and more.
B. Why do herbal supplements work?
1.
2.
3.
C.
1.
They have several active ingredients or chemicals that can influence physiological
processes; how much of the herb, the type of herb, the physiologic process effected, are
important variables in using herbal remedies.
An herbal supplement may contain all of a plants compounds, or a concentrated amount
of its active ingredients; most often manufacturer’s single out an active ingredient—
hypericin in St. John’s wort, allicin in garlic, kava lactones in kava-kava--and then
concentrate and standardize these chemicals. Whether the chemical is contained in pills, a
powder, tinctures or creams, this “standardized extract” assures that each dose will be
consistent. (“Standardized extract” is the working ingredient from the plant.)
The FDA requires that manufacturers list the active ingredients on each supplement label.
READ THE LABEL! The manufacturers are also required to list all ingredients and to
not make unsubstantiated label claims.
a.
Some contain laxatives, steroids (DHEA), alcohol up to 30% (think about
diabetics, alcoholics and children when considering herbal therapies with an
alcohol base) Website for company that makes herbal remedies for kids.
b.
Know your herbal interactions—chamomile to settle the stomach comes from the
ragweed family; echinacea from the daisy family and garlic from the tulip family,
Feverfew is from the chrysanthemum family, and St. John’s wort is from the Goat
weed—allergies to any of the flowers can rear their ugly head with just aninnocent cup of chamomile tea
What can you do to assure the quality of the product?
Use a reputable company; call the manufacturer to find out how long the company has been in
business and how a particular supplement’s potency is assured. Sticking with brand names is also
a good policy. Bigger companies usually have better quality control, because they have a
reputation and assets to protect.
a.
D.
E.
Safe companies:
Quanterra, Enzymatic Therapy, HerbPharm, Herbs Etc., Nature’s Herbs,
-Rainbow Light, Solgar Vitamin and Herb Company, Nature’s Way, General Nutrition
Center (GNC), Celestial Seasonings
Is all of the information on the Internet accurate? NO
What forms do herbs come in?
1.
2.
3.
4.
5.
F.
Tablets, capsules, softgels—usually prepared with the whole herb, often as a standardized
extract.
Tinctures--concentrated liquids made by soaking the herb in water and ethyl alcohol or glycerin.
Usually taken in small doses—20 drops or 1 ml, tid, diluted with water or juice
Tea, infusions, decoctions—less concentrated that tinctures, brewed with hot water and flowers,
leaves, or roots; decoctions use the tougher parts of the herb (stems or bark), and are simmered
for at least 30 minutes to an hour.
Oils—extracted to be commercially distilled to form potent concentrations for external use.
These so-called essential oils are usually placed in a neutral “carrier” oil, such as almond oil,
before use on the skin. Never ingest herbal oils.
Ointments and creams—made by heating fats or oils with herbs, ointments are applied to the
skin to soothe rashes and heal bruises or wounds. Creams, which are mixtures of a light oil and
water, can be used to moisturize the skin, and to relieve insect bites or sunburn. (St. John’s wort
ointment can be used for postmenopausal women to treat vaginal dryness.)
Since this is an herbal medicine it must be safe, right? Not necessarily
1.
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4.
5.
Especially if you’re pregnant
Consider all of the other medicine you’re taking or special diets
Consider other medical conditions
Be aware of herbal medicines made in China(may be laced with arsenic) and Mexico (may be
laced with arsenic, mercury, &/or lead.
See page 3 (Herbal Alert)
Top 10 Healing Herbs. Alternative Medicine Advisor. 1999.
Alternative Medical Therapies for Pain. Integrative Medicine Communications. 1999.
COMPLEMENTARY AND ALTERNATIVE THERAPIES
TARGETED THERAPIES
I. MOOD ENHANCERS, ENERGY BOOSTERS, MOOD STABILIZERS
A. The neurotransmitter theory—serotonin (hormone responsible for self-esteem) makes you happy,
norepinephrine and dopamine give you energy; boosting neurotransmitters has become the mainstay of
providing a boost of energy or elevating the mood. Traditional medicine targets these neurotransmitters by
either directly boosting their release from the nerve endings or by not allowing the usual enzymatic
reactions to re-uptake the transmitters back into the nerve endings; endorphins will also make you happy
and give you energy (sunlight boosts endorphins).
TRIVIA:

Women have 53% less serotonin than men. This is evident in the fact that > adolescent girls get
depressed than boys between 13-18 years of age.

Serotonin levels decrease in winter because of lack of sun. This may be a factor in “Seasonal
affective disorders”.
1. Serotonin Re-uptake Inhibitors—(SRI’ s)--such as paroxetine, sertraline, and fluoxetine
(Paxil, Zoloft, and Prozac)
a.
b.
c.
d.
e.
Paxil is the strongest and has the most drug interactions, better given at hs.
Zoloft is sedating and should be given at night (helpful for elderly clients due to < side effects)
Prozac is energizing and should be given m the morning; longest t l/2
Celexa is the newest kid on the block (Used in Europe for depression & dementia post stroke)
Estrogen replacement therapy has been shown to enhance the effects of the SRI’s
2. Cyclic amines—tricyclic (amitriptyline, imipramine) and heterocyclic amines (desipramine,
nortriptyline) increase both neurotransmitters— norepinephrine and serotonin
3. Estrogen, especially in combination with an SSRI—(selective serotonin re-uptake inhibitors)
4. Alternative therapies and herbal supplements
a. St. John’s Wort — “nature’s Prozac” from the klamath weed, also known as goat weed or
Hypericum perforatum L.)—an aromatic perennial native to Europe, North Africa, West Asia,
and the Western U.S. Its bright yellow-gold flowers are especially abundant on June 24th , the
traditional birthday of St. John the Baptist, hence, the name.
1. Indication: mild to moderate depression; inhibits MAO, an enzyme responsible for
breaking down serotonin and norepinephrine, boosts serotonin release from the nerve
endings, and may inhibit cortisol (which suppresses norepinephrine); hypericum extracts
are 2.7 times more effective than placebo in the treatment of depression
2. WTW—( Words of wisdom and warnings)—re: St. John’s Wort
a.
do not use with other SSRI’s, or other antidepressants—may result in the serotonin
b.
c.
d.
e.
f.
g.
h.
syndrome (tremors, hypertonicity, myoclonus, autoimmune dysfunction,
hallucinations, hyperthermia, and even death; do not use in bipolar disease
do not use on “your own” without an evaluation by a qualified health care professional
do not use with pregnancy; can also interfere with fertility
photosensitivity can be profound—use sunscreen & sunglasses to avoid cataracts
do not use with meperidine (It is an MAO inhibitor.). Stop St. John’s wort or any other
alternative therapy 2-3 weeks prior to surgery
dietary restrictions do not appear to be necessary
decreased Potassium may lead to hypokalemia. Digoxin becomes > toxic with
decreased Potassium.
St. John’s wort can induce a protein in the gut (p-glycoprotein) and kidneys that make
you not absorb meds and/or excrete meds more quickly.
3. Dosage—300mg TID of the standardized extract of 3% hypericum
b. 5-adenosyl-methionine or SAM-e (pronounced Sammy)—“the -breakthrough supplement that works as
well as prescription drugs, in half the time with no side effects.” (Brown, R, Bottiglieri T. Stop
Depression Now. Putnam, 1999)—hmmmm—too good to be true?
1. SAM-e is made naturally in the body by the combination of ATP and the amino-acid methionine.
SAM-e then donates a methyl ou t f a wide range of molecules and is subsequently transformed to
homocysteine. and supports a variety of functions, from the upkeep of cell membranes to the
production of neurotransmitters that make us “happy”
a. Placebo-controlled studies in the U.S. are lacking
2. BUYER BEWARE—pricey and fraudulent products abound; some brands sold on the Internet or in
smaller health food stores contain more baby powder and similar substances than SAM-e
(GNC & Nature’s Way are safe companies)
3. Dose—800 mg BID orally ($240.00 for a 30 day supply vs. the usual dose of St. John’s Wort
which is $15.00 for 30 days). The problem with the oral dose of SAM-e is it’s low bioavailability,
so its usefulness as an oral agent is open to question.
c. Omega-3 fatty acids—the “good” fat with cardio protective effects; -found in cold-water fish such as
salmon, mackerel, tuna, sardines and other deep sea cold water fish (Stoll A. Archives of General
Psychiatry, May 1999)
1. May dampen overactive synapses; may be simply replacing what is missing from the U.S. diet
today—MOA unknown
2. Has been shown to improve patients with bipolar disorder— especially in conjunction with their
standard medications (e.g. Depakote, Lithium—may be able to decrease dose)
3. Dosage: po supplement—may take Fish Oil capsules 7-9/day. Need TOO much cod liver oil to
have beneficial effect.
4. Encourage eating fish 3 X/week. Best fish is salmon.
d. Nature’s tranquilizer—Valerian for anxiety and insomnia; may also help tension headaches; has similar
properties to benzodiazepines and binds to the same receptor in the brain called the GABA-BZ
receptor (gamma-amino-butyric acid); don’t take with other BZ’s or booze; sudden withdrawal may
trigger DTs from Dopamine rebound.
e. Kava—sleep induction, relaxation; may prevent panic attacks; kava lactones are the active ingredient
(make sure that the extract is standardized to contain 30% of the herb’s active therapeutic ingredient—
l00-450 per day); potential interactions include booze and other sedating agents; may exacerbate the
tremor of Parkinson’s disease and other extrapyramidal effects; may decrease anxiety associated with
smoking cessation.
1. additive effects with CNS tranquilizers; do not use with BZ’s, booze, barbiturates, and antipsychotics
(like Haldol)
2. may cause itchy skin—psoriasis on upper arms, trunk, face. Almost an autoimmune reaction with
plaque, red, raised rash.
f. yoga, exercise, sunlight also boost neurotransmitters of happiness
Trivia: We need 15 minutes of sunshine every other day to keep us happy.
g. foods and moods—
1. blood sugar and serotonin—meals that stimulate a rapid rise in blood sugar may also stimulate the
synthesis of the neurotransmitter serotonin, increasing the amounts of this “feel-good” neurotransmitter
in the brain
2. When the insulin surge causes blood sugar to drop sharply, serotonin levels may also plummet, with
a corresponding dip in mood.
3. High levels of homocysteine may also cause depression—increase B vitamins as these vitamins help
decrease homocysteine levels (especially B6 & B12—100mcg/day, and Folic acid—400mcg/day)
h. What about ephedra (ma huang) for an energy boost? NO1. Ephedra tends to cause increase in BP, seizures, stroke, or MI
II. CARDIOVASCULAR HEALTH
A. The risks for atherosclerosis and heart disease are numerous. The major risk factors are genetic (1 in 500
Americans carry the gene for familial hypercholesterolemia), age (PMF females), cigarette smoking, high
dietary cholesterol (especially saturated and transfats), high homocysteine levels due to low B vitamin intake,
high iron levels , obesity (especially central obesity), infectious agents* and diseases such as Type 2 diabetes
mellitus and hypothyroidism.
* Gingivitis and strokes; plaques in the carotid arteries and dental X-rays. Chlamydia and CMV may possibly
trigger heart disease and strokes. Strep viridans present in the mouth may cause infectious stroke and can be
prevented by flossing teeth.
B. Prevention is the best medicine and from looking at the above list there are quite a few options for prevention.
C. Three types of cholesterol circulate in the blood—LDL, VLDL, and HDL; of the 3, LDL is considered to be the
most atherogenic; it is oxidized and placed directly into the arterial walls to form plaque. Oxidation plays a major
role in this process, hence the use of antioxidants (especially Vitamin E; the use of Vitamin C is controversial
now, for a lot of reasons; and it appears as if Vitamin B is not as useful as it was thought to be—omega-3 fatty
acids play a larger role-in preventing the-oxidation process than Vitamin E. Estrogen, by the way, is also an
antioxidant). VLDL’s are bad guys too, however the HDL’s are the good guys. The goal of treatment is to boost
HDL’s and lower LDL’s and VLDL’s.
Total Cholesterol = HDL + LDL + VLDL (TG/5)
Once plaques are formed, they occlude the arteries and decrease blood flow tissue supplied by that artery.
The plaques will eventually occlude the artery or they will “fissure” (rupture), attracting platelets and
initiating the clotting system. Depending on the artery occluded, the patient may have a stroke, heart attack
(myocardial infarction), or peripheral vascular disease, and/or dementia.
1..Western Medicine-exercise, diet (55% carbs, 15% protein, 30% fat), weight loss
a. The use of drugs to reduce cholesterol—”statins”—Mevacor (lovastatin), Pravachol (pravastatin),
Zocor (simvastatin), Lipitor— (atorvastatin); Niacin
Trivia: Teach to take these meds at hs because the liver works when you sleep .
The use of drugs to inhibit platelets--aspirin, Ticlid, Plavix, Aggrenox
The use of estrogen in postmenopausal females—Estrogen in a woman with NO hx of heart disease is
helpful. Estrogen in a woman who already has had an MI is contradicted.
b. Flax seeds, whole wheat, rye and fish oil (omega 3 fatty acids)— reduce LDL cholesterol and TC
c. Soy products (have weak estrogenic properties—reduce LDL cholesterol, may boost HDL
Encourage eating soybeans, tofu, soy milk, or mizo 1 – 2 X/week.
d. Lots of fiber (especially beans)—reduce LDL cholesterol; increase HDL cholesterol
e. Garlic—potent platelet inhibitor, questionable on LDL reduction; need 5 to 20 cloves per day;
Allicin is the active ingredient; stomach acidity inactivates the garlic however it is absorbed quickly
in the mouth and must be chewed before swallowing; or it can be taken in the form of an enteric
coated tablet containing dried extracts that will be rapidly absorbed in the small intestine
f. B vitamins—decrease homocysteine
g. Booze—vasodilator, platelet inhibition, may boost HDL’s; wine and beer are better than hard liquor;
how much? 4oz. wine/day, 8-12oz beer/day
2. Herbal Alternatives
a. Green Tea—4 cups per day (active ingredient is epigallocatechin gallate or EGCG to it’s friends);
contains 2-3 times more antioxidants than black tea since it undergoes less processing 1. prevents LDL-cholesterol from undergoing oxidation and “starting the plaque formation; decreases
blood pressure; decreases platelet aggregation
2. has been shown to reduce dental plaque formation if you hold it in your mouth for a few seconds
b. Arginine—a naturally occurring amino acid, and the precursor to nitric oxide in the endothelial cells of
the blood vessels, appears to have numerous health benefits, most of which are cardiovascular. Nitric
oxide is the body’s most potent vasodilator and blood pressure regulator. By vasodilating blood vessels,
arginine may play a major role in reducing anginal chest pain, lowering blood pressure, increasing
blood flow to the brain, decreasing impotence, and decreasing the complications of diabetes.
As individuals age and develop chronic conditions such as hypertension and coronary artery disease,
their ability to synthesize sufficient amounts of nitric oxide from arginine diminishes. This decline in
arginine results in further deterioration of cardiovascular status.
1. Nitric oxide and Viagra (Vitamin V or the Pfizer riser)—Do NOT take Arginine or Viagra with.
Nitroglycerine. If patient comes into ER complaining of chest pain, always ask when last dose of
Viagra (if any) was taken. You cannot give nitroglycerine for 24 hours because of risk of hypotension
or MI.
c. Gingko biloba as a vasodilator—increases blood flow to the brain to boost memory, increases blood
flow to the feet to improve circulation, increase blood flow to the genitalia to improve sexual function;
need 4-12 weeks for a positive response; 60-80 mg of the standardized extract (GBE) 2-3 times per day
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1. Gingko is also a potent platelet inhibitor—bleeding times can be 3-5 times normal when taking
gingko; four reports of spontaneous bleeding in association with the use of Gingko have been
reported—2 intracerebral hemorrhages, 1 case of bilateral subdural hematomas, and 1 case of
bleeding into the anterior chamber of the eye
2. WWW—”Until further information is available, patients who are taking garlic, vitamin E,
warfarin, aspirin or other drugs with antiplatelet or anticoagulant effects should be cautioned
about potential interactions with ginkgo products. Patients who are taking ginkgo products
should be counseled to inform their physician about unusual bleeding or bruising, new-onset
headaches or vision changes.” (Cupp MJ)
3. Gingko has also been shown to provide some positive relief for tinnitus and vertigo by increasing
the blood supply to the brain.
d. Hawthorne—a berry that has been shown to improve circulation and blood flow to cardiac muscle
(vasodilation)
1. use with caution in patients taking digoxin—may increase effects of dig
e. Ginseng—active ingredients are the ginsenosides or panoxosides, steroid-like compounds believed to
enhance the release of nitric oxide; increases blood flow to vital organ systems including heart
1. WWW—has fluid retaining properties (swollen feet and breasts and may exacerbate congestive
heart failure and peripheral edema); may negate the effects of Lasix or other diuretics; may
interfere with the function of dig (increased risk of dig-toxicity and AV block); in high doses may
cause an estrogen-like effect in males (breast development) and females (??increased risk of breast
or uterine cancer; vaginal bleeding); other drug interactions— increased risk of hypoglycemia in
diabetics on insulin or taking oral hypoglycemics; may counteract the effects of Elavil; use with
caution with nitroglycerin and Viagra
2. dose-l00-300 mg of standardized extract TID) for a total not to exceed 1-2 grams per day f. Foxglove (digitalis)—St. John’s wort may cause K+ depletion and enhance Dig toxicity; ginseng and dig
toxicity
Herbal medicines that interact with Coumadin — feverfew, garlic, ginseng, ginger, gingko, seaweed, chamomile
III.
BOOSTING THE IMMUNE SYSTEM
A. The inflammatory response and the immune response are the two systems of defense. Both systems use
various types of white blood cells to rid the body of foreign invaders. The immune system consists of B
lymphocytes that produce antibodies and T lymphocytes that produce cytokines. In addition, the
immune system has another type of “free-standing” lymphocyte known as the NK (natural killer cell)
that works on it’s own to kill invading viruses and cancer cells.
1.
Herbal alternatives for boosting the immune response:
a. Zinc 15-30mg/day—cold EEEZE— helps fight cold by increasing phagocytosis
foods high in zinc include oysters, and liver
b. Echinacea—the purple coneflower; recommended by the German Commission E, as internal
therapy for colds and chronic respiratory infections as well as urinary tract infections; has been
recommended as external therapy for wounds and chronic infections
1. the specific immune boosting properties include stimulating T lymphocyte responses,
enhancing leukocyte mobility and facilitating phagocytosis
2. doesn’t prevent colds—reduces time frame for cold symptoms
3. WWW—only use for 6-8 weeks; do not use with patients with autoimmune disease
such as MS, RA, lupus; don’t use in transplant patients or patients with AIDS (HIV) or
TB
4. Dose (read label for tablet form); Tincture form 15-20 gtts added to water every 4
hours
c. Goldenseal -an immune booster
d. Green tea—boosts B lymphocytes, T lymphocytes, and NK cells
2. Dietary boosts—vitamins A, B, C, D, E, selenium, chicken soup
Doses: A—5000 IU/day, too much may be toxic to liver
C—not more than 500 mg/day
D—400 IU/day
E—100-400 IU/day
Selenium—50-200 mcg/day. Excellent in cancer prevention
Chicken soup—potent booster of phagocytosis. Eat ad lib 
3. Exercise, humor and sunlight—all boost endorphins; Candace Pert discovered endorphins and Bill
Moyers reported on their effects in his book, Healing and the Mind.
4. Humor and IgA—tests done on saliva that measured IgA levels found that the IgA levels tripled in
persons who experienced humor. Pain levels were 5 times less, and hospital length of stay was
shortened.
IV.
PAIN MANAGEMENT
A. Dental Pain—Oil of Cloves 3-4 drops on a cotton ball and apply directly to tooth or Kava tincture 1:5 on
tooth 3-5 drips as necessary
B. Migraines—
1. Feverfew—800mg TID has been approved in Canada and Europe (may take several months), is most
effective in prevention of headaches over time.
2. Increase riboflavin and magnesium in the diet—always consult neurologist first. May recommend
400mg riboflavin daily and 400 - 600mg magnesium daily as preventative measure.
C. Arthritis and joint pain—Omega three fatty acids as prostaglandin inhibitors especially for rheumatoid
arthritis; glucosamine 500 mg TID & chondroitin 1200mg/day for degenerative osteoarthritis; SAMe for
arthritis (very expensive)
1. NSAIDS—remember that osteoarthritis pain is worse as the day progresses whereas the pain from
rheumatoid arthritis is worse in the morning; take NSAIDS at HS for rheumatoid arthritis and NSAIDS in
the late morning for osteoarthritis
2. The bark of a willow tree—contains salicylic acid (same ingredient as aspirin)
3. Embrel—new, expensive drug given IM 1 X/week to prevent hip replacement. This drug helps generate
the receptors to bind the tumor-necrosis-factor alpha and prevent joint breakdown. Does suppress the
immune system.
D. Acupuncture and AccuPressure
E. Exercise for fibromyalgia—to regain mobility
F. Hypnosis, biofeedback and relaxation techniques
V. REPRODUCTIVE CHANGES
A. Alternative therapy for menopausal symptoms, osteoporosis, heart disease, breast cancer protection
(phytoestrogens act like a rusty old key in the lock, reducing the effects of endogenous estrogen on
estrogen receptors)
1. Phytoestrogens—soy, black cohosh, chaste tree berry, red clover, flax seeds; Remifemin (OTC
preparation)—should phytoestrogens be used in women with established breast cancer?
a.
Is Premarin a “natural” therapy? Premarin made from the urine of mares.
2. Vitamin E and B complex for hot flashes; vitamin E oil to the vaginal membranes to treat vaginal
dryness
3. Topical St. John’s Wort (ointment) once or twice a week applied to the vaginal area to decrease
vaginal itching, dryness, burning (also treats the pain and itching of hemorrhoids)
4. Topical estrogens and gynecomastia in men
B. Alternative therapy for prostate enlargement—phytotherapy was first described in Egypt for the
treatment of benign prostatic hypertrophy (BPH) in the l5th century B.C.; there are about 30
phytotherapeutic compounds used for the treatment of BPH, however the most widely used is the dry,
ripe fruit from the American dwarf saw palmetto plant
1. Saw palmetto—30 days to relieve symptoms; improves urinary tract symptoms by 28%, nocturia by
25%, peak urine flow by 24% and residual urine volume by 43%; has an anti-androgenic effect and
may reduce hair on the face (? Use in hirsutism in females?)
a.
320 mg per day is the usual dose (costs $10-5O for a 90 day supply) as compared to the
medical treatment of Hytrin (terazosin) or Proscar ($120 and $200 respectively)
SELECTED BI BLIOGRAPHY
Gaster, B. 5-adenosylrnethionine (SAMe) for treatment of depression. Alt Med Alert 1999; 2(12): 133-135.
Food and Mood: can your diet affect your state of mind? Food and Fitness Advisor 1999 (June); The Center for
women’s Healthcare, Weill Medical College of Cornell University.
Cupp, MJ. Herbal remedies: adverse effects and drug interactions. American Family Physician 1999; 59(3):
1239-44.
Baker, DE. Potential drug interactions with common herbal remedies. Modem Medicine 1999; 67:57-62.
Goldberg, B. Alternative Medicine—the definitive guide. 1999 Fortune Medicine Publishing Company, Inc.
Tiburon California
PDR for Herbal Medicine. 1998 Medical Economics, Montvale NJ
Youngkin EQ, Sawin KJ, Kissinger IF, Israel DS. Pharmacotherapeutics: a primary care clinical guide.
1999. Appleton & Lange, Stamford CT.
Barb Bancroft. RN, MSN, PNP
CPP Associates
680 N. Lake Shore Drive Suite 114
Chicago, IL 60611
[email protected]
http://members.aol.com/bancbarb
773-631-6939 (phone) 773-631-6934 (fax)
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