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Arthritis

Training Clients with Arthritis

/14 September 2017/ All MFN blog/

One of the biggest challenges for fitness professionals is working around medical conditions and injuries. When a prospective client asks if you can safely train them, you definitely want to be able to accommodate their situation. But what about their limitations? What should they do and not do? How do you ensure that you’re doing the right thing as a trainer? This is especially relevant when working with arthritic clients.

What is Arthritis?

Arthritis is, in short, an inflammation of joint tissue in the body. It rears its head in many different ways and the NIH does a great job of breaking down the various facets of the condition. What it ends up doing is causing symptoms like pain, swelling, stiffness of the joint and reduced range of motion. But, most of this can be countered with the addition of an exercise program.

What a Fitness Professional Can Do to Help

This is where fitness professionals come in. Because of the fact that arthritis hits the majority of people when they are older, this also means that they might need some assistance with getting enough exercise in a safe and reliable manner.

It’s a perfect mixture — fitness professionals have a great deal of knowledge and arthritic patients have a great deal of need in this respect. Especially in the current generation retiring, the baby boomers, exercise outside of athletics was far less common than it is today. As such, there are many people who are retiring having no experience with exercise for their entire lives.

Fitness professionals like you are a great resource for getting this population treatment in the form of exercise!

Considerations to Keep in Mind

The key here is to make sure that you aren’t loading your arthritic clients with too much. The CDC’s resources on training for arthritic individuals are quite extensive and are a fantastic jumping-off point for developing your programming. For the majority of clients, it will simply be a reduced-load variation of many programs you already employ.

So let’s dive into a few:

Range of Motion

Initially, this will be one of the first things that a trainer will need to focus on. Range of motion is the key to performing other exercises. For this, a stretch/yoga approach is going to be an ideal way to go. And for people who aren’t especially limber, even just stretching will be a workout. So start light and get the range of motion up to snuff. Then you will be good to go to move on to more engaging techniques.

Don’t Let Them Skip Cardio

There can be many different objectives to a personal training program. Oftentimes, training programs will have cardio as more of an “outside the session” activity. Just make sure that they are doing some form of cardio in addition to what your normal program entails. This could be walking, cycling, swimming, using an elliptical trainer, etc. This will help these clients to improve their endurance and you should see results from this in your sessions. Whereas someone new to exercise might not be able to do pushups everyday, they can likely still do low-impact cardio.

Weight/Resistance Training

No one is talking about your clients working to be the new clean-and-jerk Olympian, but some moderate training with weights in a controlled environment can be incredibly beneficial. Developing the muscles that assist and support joint structures will alleviate some major pain that arthritic clients likely have. In addition, having a higher percentage of muscle tissue will increase the client’s basal metabolic rate, allowing them to burn more calories and lose excess weight which can add painful pressure to joints. All around, it’s a great idea. Just make sure it’s safe.

This might mean starting with slight bodyweight movements first. Once range of motion has increased, they can then start taking the exercises a little further. Resistance bands and weight machines can also be an excellent way to safely train those muscles.

Group Fitness Classes Can Be Helpful

Socializing is a great way to get through discomfort. Whereas we don’t want to push our clients to the point of pain, there will likely be a little discomfort in the beginning, especially in the first few sessions. Misery might like company, but the thing is that great friendships can be formed in such groups as well. Thus, with group fitness classes, you could help a larger segment of people with safe exercises. And, they would have a great social group to encourage one another when the going gets tough.

A Final Note

Injuries take longer to heal as people age. This is why an injury for someone with arthritis will likely be more extreme than in some of your younger clients. As such, it’s that much more essential to go slow and to not overload your clients with too much.

Additionally, make sure that your client has cleared your programming with their doctor. A client’s physician is the best initial defense from injury. Furthermore, it’s a wonderful opportunity to even partner with the doctors you come into contact with. They doubtless have many patients who do not exercise like they should. Relationships like these are win-win for everyone involved.

Jane Curth is the co-founder and CEO of FitFixNow. Helping people on their wellness journey is her passion; Jane has helped clients and students with their diet and fitness struggles for over 20 years.

muscle maintenance

Why Do You Need Muscle Maintenance?

/12 September 2017/ All MFN blog/

The human body has over 650 muscles. Skeletal muscle is the body’s largest tissue accounting for approximately 45% of body weight in men and 36% in women.

Muscles are comprised of muscle fibers. Each fiber is thinner than a human hair and can support up to 1,000 times its own weight.

Every human movement is a sequence of skeletal muscle contractions woven seamlessly together by means of a complex interaction between the body’s muscles and the nervous system.

Classified according to the duties it must accomplish in the body there are three distinct types of muscle, cardiac, smooth and skeletal.

Cardiac muscle, found only in the heart. Smooth muscle consists of slender, cylindrical fibers which are aligned parallel to form sheets of muscle. Most smooth muscle is visceral (it surrounds nearly all of the body’s organs). Skeletal muscle fibers (elongated cylinders) are bundled into groups, which are then bundled together to form what most people refer to as “muscle.”

Anchored to bones, skeletal muscle pulls on them to cause the movement to occur.

One of the many reasons why I don’t assume anything about aging is that we need to maintain muscle to move our bones and our body! When people age without maintaining muscle mass the function is lost. Balance becomes a problem and falling occurs. Muscle contributes to the functioning of both and much more.

Between the third and eighth decades of life, without muscle maintenance, people lose up to 15% of our lean muscle mass, which contributes to a lower metabolic rate. These problems have a major impact on our quality of life and health.

Maintaining muscle strength and mass helps burn calories to maintain a healthy weight, strengthens bones, and restores balance, decreasing falls. The National Institutes of Health estimates more than one-third of people over the age of 65 fall each year, often resulting in injuries such as hip fractures which are a major cause of surgeries and disability among the elderly. Balance and strength exercises can help maintain balance and reduce this risk of falling, as well as building bone.

Muscles help to improve posture, circulate blood through the body, regulate breathing, generate heat, stabilize joints, aid digestion and protect vital organs.

The body is responsive to strength training at any age. In other articles on my site I have written about researchers who have gone into nursing homes and restored resident’s ability to get rid of walkers and stand up when getting out of a chair. The benefits are tremendous. Nothing about aging should ever be assumed! Muscle has memory and when retrained it benefits our overall health and functioning. It is the best contributor to longevity that we know of!

Strength doesn’t just involve building large muscles. Lifting weights just two or three times a week can increase strength by building lean muscle. Studies have shown that even this small amount of strength training can increase bone density, overall strength, and balance. It can also reduce the risks of fractures which often occurs when falling.

Just as muscle mass declines (when not maintained) so does endurance. The good news is that the body also responds to endurance fitness training such as walking. Any activity that increases heart rate and breathing for an extended period is considered endurance exercise. In addition to walking, swimming, cycling, dancing, and tennis are all endurance activities.

Your metabolic rate is strongly influenced by our body composition. People with more muscle and less fat generally have a faster metabolic rate, while people with more fat and less muscle generally have the opposite, a slower metabolism. Every pound of muscle uses about 6 calories a day just sustain itself. While each pound of fat burns only 2 calories daily. That small difference adds up over time. After a session of strength training muscles are activated all over your body, raising your average daily metabolic rate. One pound of muscle occupies around 22% less space than one pound of fat.

Unless you are an elite athlete, resting metabolism accounts for 60% to 75% of all the calories you burn each day, and it varies a lot from person to person.

Other benefits for muscle building is better sleep. Researchers have known that short sleep leads to weight gain. People who don’t get at least 6 hours of sleep at night are prone to overeating, and they usually crave starchy, sugary foods. Also not enough sleep slows metabolism.

Researchers at the University of Pennsylvania studied 36 healthy adults into their sleep study. Even though the sleep-restricted group was active and awake for more hours of the day, their resting metabolisms slowed by about 50-60 calories a day, says senior study author Namni Goel, PhD. Goel studies sleep medicine at the University of Pennsylvania School of Medicine.

It isn’t a huge amount, but “That can add up across multiple nights of sleep restriction.” she says. Her sleep-restricted volunteers were eating around 500 more calories each day, so the total calorie imbalance just from not getting sleep was substantial – around 550 calories a day, enough to lead to about a pound of weight gain each week.

Will you fight the assumptions of aging by improving your overall health? Include muscle function and you’ll be well on your way to aging well.  Remember Ernestine Shepherd? i wrote about her last month and in other articles. She started body building at the age of 56. She is now 81! She wakes up at 2:30 a.m. every morning, consumes 10 egg whites then goes for a 10 mile run. I suspect part of her remaining day is at the gym! While everyone can’t do this, but whatever time spent is a contribution to our longevity!

Originally printed on Hormones, Health and Fitness. Reprinted with permission.

Gail Sas is a Health and Wellness Consultant with over 30 years of experience. She works with clients who are motivated towards making effective decisions in their personal health and longevity. Gail has an intensely curious mind, and loves learning and researching. She shares her content her monthly newsletter, Total Health Report. Visit her website to sign up, hormoneshealthandfitness.com.

Pregnant woman doing yoga with a personal trainer

Prenatal Exercise Program Design: Exercise Duration

/8 September 2017/ All MFN blog/

Exercise duration during pregnancy should reflect a woman’s current level of fitness and the type of activity she is doing. If you’re working with someone who’s just starting a prenatal exercise program the duration will be shorter (15-20 minutes) and progress slowly over time to 30-60 minutes. A pregnant woman who is already taking part in a fitness routine can continue with her current duration level, but exercise duration should be modified as needed to enable her to achieve a moderate to somewhat hard level of intensity without discomfort or undue fatigue.

Some exercise activities, such as swimming, may require a longer duration in order to achieve a moderate to somewhat hard intensity, so close monitoring of exercise intensity will help determine whether a longer bout is needed. As pregnancy progresses, pregnant women may find that they are able to tolerate a longer duration, lower intensity exercise bout better than a higher intensity, shorter bout, but avoid taking the intensity below the targeted zone of 12 to 14 on the 20-point scale or 3 to 4 on the 10-point scale.

In the case where a pregnant woman is having difficulty maintaining her normal exercise duration, try dividing the workout into two shorter sessions during the day. This is a helpful tool for enabling women to continue to exercise when she’s experiencing more fatigue in later pregnancy.

Want to learn more about how to develop a safe and effective maternal fitness program? The CE correspondence course “Prenatal and Postpartum Exercise Design” is available ppfconsulting.com

Catherine Cram, MS, is the owner of Comprehensive Fitness Consulting, a company that provides pre- and postnatal fitness certifications and information to hospitals, health & wellness organizations and the military.

Article reprinted from her blog with permission.

wearable-tech

Health Trackers & Apps are Dangerous… Scientists Say What?

/7 September 2017/ All MFN blog/

With over 165,000 health-related apps in the App Store and Millions of wearables in the hands of the general public, scientists are wondering if they are “doing more harm than good”? One expert commented that the field can be “likened to the snake oil salesmen of the 1860s.” Is this true?

Question: What is the danger of health-related technologies in the hands of the general public?

Answer: Because health-related technology is often “one size fits all” with the data it provides mistakenly seen as the “holy grail” that leads to improved health, it can lead individuals down a path that does not correlate with improved behaviors. This should not be a shock to health professionals as it is certainly unfair to expect the average technology user to be a “health expert” who is able to accurately analyze health data and implement the proper behavior change.

Therefore, the real question should be . . . How can the power of health-related technologies that is already in the hands of the pubic, be appropriately leveraged? Well my friends, that answer lies square in the hands of the Health Professional who fills the significant gap between the individual and technology they use. I call this the Technology-Behavior Change Triad© (Details in the next article in this series).

Where the Rubber Meets the Road: While working with clients and patients for over 5 years we have successfully integrated health-related technologies with our patients and clients. During this time we have found them to be the key tool for providing patient-matched, actionable feedback related to long-term behavior change. Think about it, how else can we get “real-time”, individualized information from clients or patients when they are not with us? What’s more, smartphones and wearables are already in the hands in just about ALL of our current and potential clients and patients so as professionals we are remiss if we disregarded the use of this technology.

The Take Home Message: Health-Related technology provides valuable information to the end user. Can this be harmful? Well, the question really should be . . . How can this technology be most impactful for improved health? Simply put, the Health Professional can harness the power of Health-Related technology when it is integrated within the client or patient relationship. In the end, not only do these tools allow the creation of the best individualized motivational environment for each person, but they also take your business to the next level as you optimize your service offering with more efficient and effective engagement!

Reprinted with permission from Dr. Steve Feyrer-Melk.

Steve Feyrer-Melk, MEd, PhD, is a powerful, passionate, and trusted authority in Lifestyle Medicine who is bringing an innovative, refreshing, and successful approach to proactive health care. Dr. Steve co-founded the Optimal Heart Attack & Stroke Prevention Center where he crafts and hones real-world programs for immediate impact. Dr. Steve also serves as the Chief Science Officer of Nudge, LLC, a lifestyle medical technology company.

senior woman doing exercises

If Exercise is Medicine for People with Parkinson’s, Why Isn’t Everyone Doing It?

/1 September 2017/ All MFN blog/

The three national thought leaders presenting at the Annual Parkinson’s Symposium in 2015 were all in passionate agreement: exercise is imperative in treating the symptoms of Parkinson’s disease. We have cultivated and grown many Parkinson’s-specific exercise programs in Sarasota County, from spin classes to yoga, at levels appropriate for all stages of the disease. In addition, exercise is the only know treatment modality with 100% positive side effects!

So why isn’t everyone doing it?

As a Care Advisor and Health Coach, I am continually striving to understand what motivates or inhibits people from exercising. Why are some in our Parkinson’s community committed exercise enthusiasts, while others seem to come up with innumerable reasons why they can’t participate in physical activities?

I believe a core reason may be what the American Council of Exercise refers to as the concern for “psychological safety.” If someone has Parkinson’s, that person may believe that participating in exercise is dangerous. A fear of falling, freezing of gait, or muscle stiffness preventing completion of an exercise class may prevent a potential exerciser from starting a program that could help reduce all these symptoms.

People with Parkinson’s may also have heightened feelings of self-consciousness, and may fear embarrassment while participating in a class setting. Gyms can be intimidating, and often it is difficult to know where to start. Even the most structured and supervised exercise classes have some levels of unpredictability.

Another concern people with neuro-degenerative diseases face is coming to terms with diminished physical abilities. If a person with Parkinson’s has had an active and athletic past, it may be difficult to acknowledge what the body can no longer do. Seeing others at later stages of Parkinson’s may dissuade someone from attending an exercise group that could slow down the progression of the disease.

So how can we address these concerns? Those with Parkinson’s first need to know that they are not alone, that there are many people fighting this disease with exercise and are having fun doing it. Finding a safe and effective exercise class with qualified professionals in a supportive environment is the next step. Often times it is less intimidating to attend an exercise class with a spouse or friend, and always know that if you are new to exercise, you will always be encouraged to go at your own pace until you become more confident in your abilities. Finally, not only do regular exercisers have fun and empower themselves with the ability to help diminish their Parkinson’s symptoms – they become stronger in body, attitude and spirit. Be a Parkinson’s fighter.

Carisa Campanella, BA, AS, is an ACE Health Coach and ACSM Personal Trainer. She is the Program Manager at the Neuro Challenge Foundation for Parkinson’s. Neuro Challenge provides ongoing monthly support groups and educational programs, individualized care advising and community resource referrals to help empower people with Parkinson’s and their caregivers.

mother-with-stroller

Postnatal Exercises

/23 August 2017/ All MFN blog/

Exercise is recommended to keep the body strong and in proper working order. Exercise also builds and maintains healthy joints, bones and muscles. Postnatal exercises help a woman get back into shape after giving birth, and they also help combat postpartum depression. There are several basic exercises you can do within a few weeks after giving birth. However, if you’ve had a Caesarean section, you may want to wait at least six weeks before doing any abdominal exercises. If you experience pain while exercising, stop immediately and call your doctor for advice.

Walking

Walking is the most basic of exercises, and it’s a good way to begin a new workout regime. Begin by walking at a leisurely pace, and increase your pace and distance over time. Once you’re comfortable in your movements, take advantage of all those great baby registry gifts you’ve received. Put the baby in the baby carrier and push the child in front of you as you walk.

Some women enjoy walking with a friend, as it gives them time to socialize, an activity you may be neglecting while caring for your new baby. If you are a runner, avoid an intense running workout until you have spoken with your physician. Some women are discouraged from exercising strenuously in the first few weeks after giving birth, especially if they are waiting for the wound from a C-section to heal. A doctor can answer questions about your limitations.

Pelvic Tilt Exercise

The tummy is a major problem area for many women after giving birth. Thus, pelvic exercises are often helpful. The pelvic tilt exercise is easy to do and can tighten up your stomach and strengthen your back. Begin on your back on the floor with your knees bent and your feet flat against the floor. Then, flatten your back against the floor as you tighten your abs and lift your pelvis slightly off the floor. Hold this position for 10 seconds. Repeat the exercise by doing three sets of ten seconds each. Pelvic tilt exercises can be done anywhere. After you’ve finished breastfeeding and put the baby down for a nap, take a few minutes to do your exercises.

Kegel Exercises

Some people worry about finding the time to exercise. However, both pelvic tilts and Kegels can be done in a short time frame. The purpose of Kegel exercises is to strengthen the muscles in your pelvic floor. During pregnancy, the muscles of a woman’s pelvis are often weakened. This is why some women experience incontinence after childbirth. If you notice that coughing, sneezing or laughing causes you to leak small amounts of urine, then you could probably benefit from Kegel exercises.

Kegels are simple. First you must identify your pelvic floor muscles. These muscles are the ones you use when you stop yourself from urinating mid-stream. Practice stopping and starting urination while in the bathroom, but only do this once or twice to identify the proper muscles. Do not make a regular habit of contracting your muscles during urination, as this can cause bladder problems.

Once you’ve identified your pelvic floor muscles, you are prepared to do Kegels. Lie on your back and contract your muscles for five seconds, and then relax for five seconds. Do this until you can contract for ten seconds at a time. Do three sets of ten seconds 2-3 times each day. You can even do Kegels while standing up and walking around. Kegels can help those who leak a small amount of urine but probably won’t be helpful to women with a serious incontinence problem.

Forearm Planks

Planks are good exercises that target and tone your abs, thighs and butt. Planks are also a great way to strengthen your abs without straining your back and neck. Begin by lying on your stomach on the floor. Put your forearms on the floor beneath your shoulders and keep your back straight with your legs extended so that your toes touch the floor.

Then, lift your tummy from the floor so that it is parallel to the floor. Using your forearms and toes to hold your body weight, tighten your tummy and hold your abs off the floor for 30-60 seconds. Rest for 30 seconds, and then repeat the exercise 4-5 times. You can also do planks with your palms flat against the floor and your arms straight rather than placing your weight on your forearms.

Finding time to exercise after giving birth can be a challenge. Try to schedule a brisk walk several times weekly at a local park, or simply walk around your neighborhood. Any exercise is better than none at all. Kegels, pelvic tilts and planks can be done inside your home. Take a few minutes several times a day while your baby sleeps to do your exercises. It’s also a good idea to have your doctor recommend stretches and workout routines. Remember to start light, then increase your exercise intensity over time.

I’m the woman next door, with all of the problems and joys of everyday life. I know that the more I give, the more I’ll receive–so my blog is intended to help people, and hopefully, it will do good things for me too. As a working mother, I’m often faced with many practical, everyday situations that make life harder, but that shouldn’t be the case. Visit my website at thebabbleout.com

Sources
http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/kegel-exercises/art-20045283
http://www.webmd.com/parenting/baby/6-exercises-for-new-moms#2
http://kemh.health.wa.gov.au/brochures/consumers/postnatal_exercise.pdf

blood-samples

The Rise of Consumer-Based Blood Testing: A Huge Step Forward for the Medical Fitness Profession

/18 August 2017/ All MFN blog/

A recent report in Forbes Magazine by writer Unity Stokes discusses the recent issues concerning the validity of blood tests results from a Silicon Valley lab company called Theranos. Theranos was founded by a 30-something Elizabeth Holmes, who garnered over $5 billion from investors to launch her company that promised blood from finger sticks vs. whole venous blood draws. This year her company was investigated by the Department of Justice for investor fraud. Today Theranos has little investor value, but Ms. Holmes helped launch the consumer based blood lab model – in which patients can order blood labs from online companies when they want – essentially taking away a physician-ordered medical procedure.

While it may not mean too much for medical fitness professionals today – it should. There are two reasons. Even though Theranos is not the top dog in the blood lab industry now – they have changed the way we think of blood labs in general.

The big picture here, as explained by Stokes in his article, is that whatever the endpoint is for Theranos, consumer based lab testing is here to stay and will be one of the fastest growing areas of healthcare.

Simply put – consumer based blood lab companies allow patients to log onto web sites and essentially become “members” of an online community. Their membership allows them to receive blood labs independent of their physician referral.

Why is this important? For the Medical Fitness Professional – it is the game changer that they have been waiting for. Over the past 25 years they have pushed the terms “post rehab exercise” and “clinical exercise” to allow trainers to move into the health care environment.

While performing duties that may in some cases seem similar to physical therapy (in the eyes of the uneducated observer) they are now able to have a piece of health care that they can use to further their development of the clinical exercise realm.

Blood labs will allow personal trainers, health coaches, health nurses, sports conditioning coaches, and exercise physiologists to refer their clients and athletes to blood lab companies online and directly test the effects of an exercise and sport program on their health.

According to StepOne Health CEO Craig Brandman, MD – over 90% of healthcare decisions are make by the results of blood labs, and in sports medicine – we can only imagine looking at blood labs on an on-going basis to see how our prescribed exercise (or sport) program is doing on blood lab parameters.

Take diabetes for instance – in athletics or health improvement, the basis for medical decision making is in two critical areas – fasting and post blood glucose testing with a home monitor and long term care regarding the glycosylated hemoglobin (A1c). These tests are crucial to seeing how improvements are doing in overall diabetes health. The first test – the home glucose monitor – can be used in any health club and by anyone. The A1c test is a lab test and is usually prescribed by a doctor – until now.

Dr. Brandman and myself have been in communication for some time to bring StepOne Health into the realm of the health and fitness profession. As a former medical researcher – I can’t agree more. With cancer patients, weight management, hormone management, cardiovascular risk patients, and most others, the ability to manage blood labs may be the most important element in showing others in health care the benefits of exercise and sports training at any level.

Sports training programs rely on physical performance markers, injury status, range of motion, and other elements to see the improvement in athletes. Blood testing allows them to not only measure acute markers (blood glucose, lactate, etc.), but to look at markers such as Creatine, Testosterone, and BUN levels and prescribe fitness accordingly.

How will this come to pass? In my conversations with Dr. Brandman – we are working on two fronts. First is to enhance the education of health and wellness professionals as a whole. The Blood Lab Wellness Specialist course was launched in February of 2016, and it allows heath and wellness professionals to have a baseline understanding of the blood lab process. Second – StepOne Health will be creating a referral-based system whereby Medical Fitness Professionals and coaches can directly refer clients to the StepOne Health portal and become part of the referral family. This will include discount rates on blood panels, referral fees for professionals, genomic testing profiles, and online coaching when needed. In my opinion, it is the single most important step in bringing wellness and fitness into today’s health care system as any single faction.

I recently had the opportunity to interview Dr. Brandman about the issues concerning healthcare. In his opinion, health and fitness professionals SHOULD be referring clients to blood work. The more clients know about how their fitness impacts their overall health status, the better. See the interviews with Dr. Brandman on my medhealthfit YouTube Channel here:

https://www.youtube.com/watch?v=NFco-TrQ_hw
https://www.youtube.com/watch?v=O7IFebUXpXU

Lastly – the profession of medically based exercise is steeped in our tradition of sports medicine. Allowing for blood lab data (under HIPPA guidelines of course) to steer the course of exercise programs makes for formidable outcomes measures and research. It will allow practitioners to absolutely have clear cut outcomes on the programs they are teaching and will only strengthen the association with medical practice groups, hospitals, and health plans, who are looking for the best opportunity to work with providers at the best possible pricing. It is a win for all parties – especially patients, who can see how exercise truly affects their health status.

For more information – log onto www.steponehealth.com and look over the web site.

For more information on the Blood Lab Wellness Specialist, visit medhealthfit.com/health-lab.

Eric Durak is a pioneer in the post rehab movement. He has worked in personal training, medical research, environmental health, and is the author of numerous industry certification courses, such as the Cancer Fit-CARE program / coaching program, Fitness Medicine, Wellness @ Home, The Insurance Reimbursement book for wellness professionals, and recently – the Blood Lab Wellness Specialist. See all of his programs at the medhealthfit.com web site.

References

http://www.forbes.com/sites/unitystoakes/2015/11/04/despite-clamor-surrounding-theranos-the-entrepreneurs-vision-of-transforming-diagnostics-is-near/

http://www.inc.com/magazine/201510/kimberly-weisul/the-longest-game.html

http://www.wsj.com/articles/theranos-is-subject-of-criminal-probe-by-u-s-1461019055