Why is it that loneliness is twice as dangerous as obesity, impairs immune function, and aggravates inflammation? Why is loneliness only increasing in modern populations? These questions are vital in understanding that contrary to popular perception, loneliness is not just a feeling in your head; it has also been correlated with serious health risks.
This phenomenon is known to bridge the gap between emotional and physical states. Those that are lonely do not sleep well, bringing about a situation that can cascade into a range of health issues since sleep is arguably one of the most important bodily functions. Loneliness also has the tendency to perpetuate itself, as those affected pursue further social evasion by avoiding those that can’t be trusted. On top of that, loneliness can be difficult to remedy because it has little to do with the number of people in one’s social circle, but rather the quality of those people. Jessica Olien from Slate writes of her own experience:
Over the winter I moved from New York City to Portland, Ore. The reasons for my move were purely logical. New York was expensive and stressful. Portland, I reasoned, would offer me the space and time to do my work.
Upon arriving, I rented a house and happily went out in search of “my people.” I went to parks, bookstores, bars, on dates. I even tried golfing. It wasn’t that I didn’t meet people. I did. I just felt no connection to any of them.
Once social and upbeat, I became morose and mildly paranoid. I knew I needed to connect to people to feel better, but I felt as though I physically could not handle any more empty interactions. I woke up in the night panicked. In the afternoon, loneliness came in waves like a fever. I had no idea how to fix it.
But it can definitely be fixed. Any method of finding people that you can share a connection with will work well. Specifically, online dating websites have yielded high success rates in relationship longevity, and in response, networks have sprung up geared towards just finding a friend. A real connection with someone is a great way to find happiness and fulfillment, and whether you would rather make it happen by joining a gardening club or reaching out on an internet site, you are also on the path to a healthier life.
If you find yourself experiencing the winter blues or feeling down it could be seasonal depression. It is more common than you think but too often men ignore the signs and avoid help out of fear of the stigma. But there are several things brothers can do for self-care to help overcome depression and restore peace.
Even if going to a spa is out of the budget, there are chair and hand-held massagers available at stores like Wal-Mart and Target that can be used in the comfort of your own living room. If it’s just too cold to go outside, the next best thing to a massage is a hot bubble bath with some soothing music in the background as this helps to increase the blood flow to muscles and allows you to relax.
Chronic stress can produce too much cortisol, a hormone that can ramp up appetite — and lead to overeating. A simple exercise like walking, just 30 minutes every day helps to incorporate a great way to to minimize gaining weight and stress reduction all in one.
Nap time. Too little sleep causes slowed metabolism and increased appetite which risks overeating, unhealthy food choices, and inactivity. Most of us don’t get enough rest and curl up with a good book, have some hot cider or tea before lying down but it can help us fall asleep faster when one is just too stressed to relax.
Studies show that financial stress is one of the main reasons Black men worry. Don’t plan to make any large purchases on credit until you are out of debt. And pay yourself first, even if it’s only a dollar a week which you should put into an account at your local credit union to avoid fees.
Take up restorative yoga, tai chi or meditation! These mind-body strategies incorporate improving posture, relaxing, and stretching to improve balance and coordination while simultaneously decreasing stress. Take time to breathe deeply and say a prayer, or just sit down in a quiet place and simply meditate with relative peace and quiet.
Never underestimate the power of a good sex life and reconnecting with your significant other. And yes, it’s okay to masturbate. Enough said.
Comedy is good for the soul. Whether it’s rented movies, downloaded comedy sketches or even going to improv or karaoke, a good laugh goes a long way. Laughter lowers stress hormones and improves blood flow, which increases your energy levels. The more energy you have, the less likely you’ll be to be overwhelmed by depression that sometimes comes with the winter season.
In the interview above, I talk with Stephanie Stephens from Mind Your Body about ways to control pain while avoiding surgery and pills. If you’re wondering what viscosupplementation is, or how radio frequency ablation works you’ll find the video helpful. Additional topics include: epidurals, TENS unit, pain pumps, and nerve/facet blocks.
While movement with osteoarthritis can be arduous, it actually can be a great way to relieve pain when done right. Some of the keys to look for in a good approach to exercise is a focus on low impact movement and, not surprisingly, fun. In a recent piece for EverydayHealth, I discuss how activities such as tai chi and water aerobics can improve your quality of life. By both strengthening your body and alleviating stress, these 5 activities can make life both more comfortable and enjoyable. Give them a try!
I am pleased to announce that I will be co-hosting a new radio show! Late Night Health Radio will offer professional insight into a variety of important health issues, while providing a special focus on America’s baby boomer generation. The host, Mark Alyn, with 20 years of experience as a television host and reporter, will join me in discussing health tips, the newest studies, and tackle subjects like pain management, and dealing with diabetes and cancer. I’ll be contributing thorough coverage of my specialty in pain relief and rehabilitation, joined by special guests such as Dr. Gorodisky M.D. and many more!
Be prepared to be informed and entertained. More details are coming soon. To stay up to date on the latest Late Night Health Radio developments, visit the official website.
While cyclists tend to be very fit due to their love of the sport, there are some risks involved. In a recent article Nina Patterson, PT, explains that many injuries are inflicted on areas of existing weakness, with the compounding effect of additional stress or under-use in certain areas of the body. In each case, she says, the injury occurred due to “cumulative trauma.” So what can be done about these injuries?
She specifically tackles widespread issues such as neck pain, low back pain, hamstring strains, and Achilles tendon strains, and discusses how active release techniques can help with a problem that other therapeutic activities couldn’t solve. Read the article at the Sports + Orthopedic Leaders Physical Therapy blog and start living a more pain free life.
Active Release Techniques® (A.R.T.*) is a soft tissue management system that breaks up adhesions in and between tissues. Using A.R.T., normal length and tension of tissues is restored. For those of you who have tried stretching and general massage with no avail, A.R.T. is for you.
Chronic pain has the ability to strip individuals of their productivity, happiness, and well-being. ABC News wrote this great piece about Tiiu Leek and her pain in the workplace, describing how women feel more pain than men do. The article references a relatively new study from The Journal of Pain that showed women generally feel more pain than men. However, this study wasn’t thorough since it didn’t account for confounding factors such as emotional effects or an additional painful disease. Women tend to be better at analyzing and describing their pain to doctors which give the illusion they feel more pain. As a culture, men are expected to complain about pain less as well as talk about their emotions. One’s mental well-being has a huge effect on physical pain, thus conclusive studies are hard to produce. Nevertheless, the findings reflect what I see as a chronic pain specialist. Here is a telling excerpt from the ABC News article:
Meyer saw 13 doctors before she got a proper diagnosis and the majority were men. “It’s very uncomfortable for them to see real emotion: ‘Tell me the facts, m’am, just the facts.’ I see them tune out.”
Now, she consciously spares the doctor the emotional talk. “I can literally be in so much pain I am crying when the staff is in there, but I pull it together when the doctor is in the room and have no tears at all. And it’s not easy to have to do that.”
She said doctors need to listen more to their female patients – “feelings are a part of the equation … Patients shouldn’t have to shut things down.”
Both Meyer and Leek sit on the leadership circle at For Grace, an advocacy organization that educates, supports and empowers women in pain through annual conferences and legislative outreach.
For Grace’s “Fail First” bill recently got through the California State Assembly’s appropriations committee on a 12-5 vote. If signed by the governor, it will allow women in pain much better access to pain medications, bypassing insurance companies.
As for Leek, she has seen marked improvement in her pelvic pain thought exercise and homeopathic approaches. She also tries to surround herself with positive people.
“My career was lost, but not my optimism,” she said. “I continue to live well. I once read that if you can get through your 60s unscathed, you can have a pretty good life.”
Read this article on ABCnews.com
Many consider pain to be a physical sensation. It seems too obvious that pain originates around the body because that's where many feel it, but in reality pain is created in your mind. Since we perceive the world through our brains as we gather external sensory information from our surroundings, any sort of pain we feel becomes reality. In this way, heartache and mental pain can surprisingly cause physical pain. As acknowledged by the holistic medicinal community, one's mental well-being can effect how their physical bodies feel. In this recent Scientific American article, author Christie Wilcox explores how emotional turmoil caused by those close to us can have very real and physical results:
I know I’m not physically hurt. Though it feels like I’ve been kicked in the stomach with steel-toed boots, my abdomen isn’t bruised. Spiking cortisol levels are causing my muscles to tense and diverting blood away from my gut, leading to this twisting, gnawing agony that I cannot stop thinking about. I can’t stop crying. I can’t move. I just stare at the ceiling, wondering when, if ever, this pain is going to go away.
It doesn’t matter that my injuries are emotional. The term heartache isn’t a metaphor: emotional wounds literally hurt. The exact same parts of the brain that light up when we’re in physical pain go haywire when we experience rejection. As far as our neurons are concerned, emotional distress is physical trauma.
Evolutionary biologists would say that it’s not surprising that our emotions have hijacked the pain system. As social creatures, mammals are dependent from birth upon others. We must forge and maintain relationships to survive and pass on our genes. Pain is a strong motivator; it is the primary way for our bodies tell us that something is wrong and needs to be fixed. Our intense aversion to pain causes us to instantly change behavior to ensure we don’t hurt anymore. Since the need to maintain social bonds is crucial to mammalian survival, experiencing pain when they are threatened is an adaptive way to prevent the potential danger of being alone.
Of course, being able to evolutionarily rationalize this feeling doesn’t make it go away.
I lie flattened, like the weight of his words has literally crushed me. I need to do something, anything to lessen this ache. The thought crosses my mind to self medicate, but I quickly decide against that. Mild analgesics like ibuprofen would be useless, as they act peripherally, targeting the pain nerves which send signals to the brain. In this case, it is my brain that is causing the pain. I would have to take something different, like an opioid, which depresses the central nervous system and thus inhibits the brain’s ability to feel. Tempting as that might be, painkillers are an easy – and dangerous – way out. No, I need to deal with this some other way. Slowly, I sit up and grab the guitar at the foot of my bed.
Where music comes from, or even why we like and create music, is still a mystery. What we do know is that it has a powerful affect on our brains. Music evokes strong emotions and changes how we perceive the world around us. Simply listening to music causes the release of dopamine, a neurotransmitter linked to the brain’s reward system and feelings of happiness. But even more impressive is its affect on pain. Multiple studies have shown that listening to music alters our perception of painful stimuli and strengthens feelings of control. People are able to tolerate pain for longer periods of time when listening to music, and will even rate the severity of the sensation as lower, suggesting that something so simple as a melody has a direct affect on our neural pathways.
So, too, does self expression. Expressive writing about traumatic, stressful or emotional events is more than just a way to let out emotion – college students told to write about their most upsetting moments, for example, were found to be in remarkably better health four months later than their counterparts who wrote on frivolous topics. These positive results of self-expression are amplified when the product is shared w
So, I begin to write. At first, it is just a jumble of chords and words, haphazardly strung together. But, slowly, I edit and rewrite, weaving my emotions into lyrics. I play it over and over, honing the phrasing, perfecting the sound.
The rush of dopamine loosens the knot in my stomach ever so slightly. For now, the agony is dulled. Still, I can’t help but think that I’m never going to really feel better – that the memory of this moment will be seared into my brain, and a mental scar will always be there, torturing me with this intense feeling of loss.
Scientifically, I know I’m wrong. As I close my eyes, I am comforted by the thought that the human brain, though capable of processing and storing ridiculous amounts of information, is flawed. The permanence of memory is an illusion. My memory of this moment will weaken over time. It will be altered by future experiences, until what I envision when I try to recall it will be only a faint reflection of what I actually feel. Eventually, this pain won’t overwhelm me, and I will finally be able to let go.
Read and comment on this article on ScientificAmerican.com.
Do winter blues have you down? Here are some simple, inexpensive ideas to rejuvenate your body and improve your mood throughout the winter season.
Even if going to a spa is out of the budget, get yourself a handheld massager to use in the comfort of your own living room. And when it’s cold out, the next best thing to a massage is a hot bubble bath with some soothing music. You get the added benefit of increased blood flow to muscles, helping you relax. Music itself can be a relaxing way of helping you take your mind off your worries as it is the universal language of emotions. From timeless classics to contemporary jazz, indie, and fusion, the secret is to turn the volume down so low that it is almost imperceptible. This little trick allows you to focus on listening and helps silence racing thoughts.
Chronic stress can produce too much cortisol, a hormone that can ramp up appetite and lead to overeating. A simple exercise like walking just 30 minutes a day helps facilitate weight management and stress reduction all in one.
Nap time. Sleep loss causes slowed metabolism and increased appetite, putting us at risk for overeating, unhealthy food choices, and inactivity. Most of us don’t make enough time for rest. Curling up with a good book and some hot cider or tea before lying down can help us fall asleep faster during stressful times.
Cutting your expenses is a good idea any time of the year. Studies show that financial stress is one of the main reasons adults worry. This concern can be transmitted to your kids. While most kids don’t bear the financial responsibility of their parents, they can often sense something is wrong. Save money by drinking water instead of coffee and sugary beverages. Don’t plan to make any large purchases on credit until you are out of debt. Lastly, pay yourself first, even if it’s only a dollar a week.
Take up mood-boosting yoga, tai chi or meditation! These mind-body strategies incorporate improving posture, relaxing, and stretching to improve balance and coordination while simultaneously decreasing stress. Take time to breathe deeply and say a prayer, or just sit down in a quiet place and simply meditate with relative peace and quiet.
Never underestimate the power of a good, healthy sex life and reconnecting with your significant other. Enough said.
Comedy is good for the soul, and there are clear health benefits of laughter. Whether you rent movies, download comedy sketches, or even go to improv or karaoke, a good laugh goes a long way. Consider taking your kids or young family members skating, skiing, or snow boarding, where everyone is engaged in lighthearted physical activity. Laughter lowers stress hormones and improves blood flow, which increases your energy levels. The more energy you have, the less likely it is you’ll be overwhelmed by depression that sometimes comes with the winter season.
This article was featured on SutterHealth's "MyLifeStages".
Interview length: 56 minutes — Interview date: November 21st, 2011
In this interview with Dr. Michael A. Lenoir on KPFA Radio's About Health, we touched on acute vs. chronic pain, Michael Jackson and dietary considerations. We answered many listener questions regarding increased sensitivity to pain, acupuncture, avoiding surgery, chiropractors, arthritis, the stress caused by pain, and more.
Ken McCoy recently interviewed me on his radio show. We had a great time discussing what pain management is, what pain management specialists do, and my philosophy regarding pain management in general. Click the play button on the audio player above to listen to our segment. Here’s an overview of what we talked about:
Trying to get patients to understand their medication: Medication is extremely important to many, but some forget what their medicine is supposed to be doing for them. Sometimes they no longer need to be taking it.
Ken McCoy and I also discuss how I got started as a pain management, physical medicine, and rehabilitation specialist. * We discuss how the holistic approach to treating patients and the future of medicine/health.
Taboo Talk: a talk show featuring Lady Charmaine Day, Pastor and Christian Consultant of Unlimited Help Ministries Unlimited Help. Today Lady Charmaine talks to Dr. Moshe Lewis — Pain Management Specialist — about staying healthy and new advances in pain treatment technology:
Relatively clear evidence emerged to suggest that t'ai chi is effective for fall prevention and improving psychological health and was associated with general health benefits for older people. t'ai chi is a practice that combines deep breathing and relaxation with slow and gentle movements and is based on the Confucian and Buddhist belief that health is controlled by 2 opposing life forces, yin and yang. This is based on a recent extensive review of the literature by Myeong Soo Lee as reported in the May 16th British Journal of Sports Medicine.
However, t'ai chi seems to be ineffective for the symptomatic treatment of cancer and Rheumatoid Arthritis. Interestingly, a separate paper that was presented at the Royal College of Nursing’s research conference within the same week has found that T’ai Chi sessions may “help those with rheumatoid arthritis to gain increased self-efficacy and confidence through greater control over their mobility and condition within a supportive environment.”
It is also important to note that Tai Chi is only one form of Qi Gong. The various aspects of Qi Gong exercises can be even more beneficial for your health. T’ai Chi was developed hundreds of years ago in China as a series of graceful physical movements combined with deep breathing, and is now thought to be practiced by at least 2.5 million people around the world.
“I don’t understand it. I am successful in so many other areas of my life. It’s just with eating that I can’t seem to control myself. I’ve tried everything”.
Many of my clients say something similar to this when they first come to see me. Often they are successful and accomplished and their friends and colleagues, even their family, think they have it all together. Inside, however, they often feel trapped by overeating, low self-esteem, and sometimes bulimia, anorexia, or other eating disorder. They may be overweight, or they may not.
What is it that keeps them trapped? It’s the “Cycle of Overeating”.
FEEL BAD => EAT => FEEL GOOD => GUILT => FEEL BAD
This cycle generally starts sometime during our formative years. We experience emotional pain, and don’t know a constructive way to deal with it. This pain makes us FEEL BAD. We hate feeling bad, so we look for something that will make us FEEL GOOD, not in a week or a month, but right now in the moment that we are feeling bad. We try eating and find that at least temporarily, it makes us FEEL GOOD, right now. Great! We have found a solution that works.
Then, if we have eaten too much, we feel GUILT. GUILT makes us FEEL BAD. We hate feeling bad, and want to FEEL GOOD, right now. So we do what we know works, we EAT! Now we FEEL GOOD. Then, of course comes the familiar GUILT, for having eaten too much, and it very effectively gets us to FEEL BAD again. This is a perfect self-sustaining cycle: FEEL BAD => EAT => FEEL GOOD => GUILT => FEEL BAD, and it begins again.
So the real question is, how do we break this cycle? Diets, by their very nature, are directed at getting us to not eat, and therefore, we don’t get to FEEL GOOD, right now. We get to FEEL GOOD in a week, or a month when the scale brings good news or our clothes become loose, but not right now.
Willpower can carry us through for some time-weeks, months, even a year. Yet at some point we feel emotional pain again, the kind that we really hate to feel, and we break down. We eat again. We say “ Just this once won’t matter” or even the more bold “If this is what it takes to get me through this, then so be it”.
Breaking this cycle by trying not to eat is a strategy that is doomed to failure because it doesn’t teach us a new way to get out of feeling bad in the short-term.
So, what will work? One approach is to break the cycle by reducing the sting of the guilt. If you don’t feel the guilt, then you won’t FEEL so BAD, and won’t have to fix that feeling by eating.
This guilt-neutralization strategy is a good one, especially for short-term relief. Ultimately, however, one has to learn a new strategy to process and release the emotional pain, without eating. While you may be thinking “how many years of therapy will that take?”, it’s comforting to know that there are some quick and effective strategies that you can do on your own. One of my favorites is the more Eastern approach of leaning right into the pain and deeply breathing into it. Through this process, we come to realize not only that the pain won’t kill us, but also that it typically on its own.
By both neutralizing the guilt, and releasing the pain that’s been fueling the cycle, we can truly heal the cycle of overeating.
A former food addict, Renée Stephens is the host of iTunes top weight loss podcast “Inside Out Weight Loss”, with over 3,000,000 downloads to date. She is featured in the breakthrough film “The Inner Weigh” available at www.theinnerweigh.com/renee. She has consulted with Weight Watchers International as a behavioral weight loss expert, and coaches by phone and in person out of her San Francisco office. Her website is www.reneemethod.com.
Osteopaths use a broad range of gentle hands-on techniques including soft tissue stretching, deep tactile pressure, and mobilization or manipulation of joints.
The philosophy of Osteopathy is what sets it apart from other medical disciplines. The key principles are based on all parts of the body functioning together in an integrated manner. If one part of the body is restricted, then the rest of the body must adapt and compensate for this, eventually leading to inflammation, pain, stiffness and other health conditions. When the body is free of restrictions in movement, Osteopathic treatment assists the body with pain minimization, reduced stress and greater mobility providing the body with the opportunity to heal itself.
The National Center for Complementary and Alternative Medicine states that overall, studies have shown that spinal manipulation can provide mild-to-moderate relief from low-back pain and appears to be as effective as conventional medical treatments. In 2007 guidelines, the American College of Physicians and the American Pain Society include spinal manipulation as one of several treatment options for practitioners to consider using when pain does not improve with self-care. Recent research into spinal manipulation for low-back pain has begun to look at the effects of different forms of manipulation, as well as treatment duration and frequency. Studies have found that spinal manipulation provides relief from low-back pain at least over the short term (i.e., up to 3 months), and that pain-relieving effects may continue for up to 1 year. Spinal manipulation is generally a safe treatment for low-back pain. Serious complications are very rare.
The best way to find a good osteopath is by asking for referrals from friends, doctors, or other health experts. Health food and supplement stores will often have advertising material from osteopaths and other holistic health practitioners, but the best way to locate a really good osteopathic doctor is by finding somebody who experienced great results with osteopathy – and finding out who she or he saw. On the web start with the American Osteopathic Association here, www.osteopathic.org
About 10 years ago, the South San Francisco resident was coping with mobility issues and chronic pain after retiring as a firefighter due to a disability.
He went through years of physical therapy until, in recent years, his doctor recommended a treatment known as myofascial release, which decreased his pain and made him more mobile again.
Wanting to help others coping with chronic pain, Fitzpatrick and his doctor recently discussed his successful treatments on an episode of ABC7 TV's "Beyond the Headlines."
Read more at Mercury News: From roller derby to art gallery
I recently helped write an article on managing Arthritis pain with Healthline.com. It’s comprehensive and gives quite a few treatment tips that pain management specialists prescribe. If you are currently suffering from Arthritis, I highly recommend you employ some of these methods. Here is the list of the categories they dive into:
More than 40 million Americans are affected by Arthritis. If left untreated, arthritis can become a chronic condition with symptoms of severe pain and swelling that seriously disrupts everyday life. Learning how to live with arthritis can be extremely difficult, but by making healthy lifestyle changes and incorporating different treatments, you can manage the symptoms and improve your quality of life.
Treatments for arthritis will depend on your individual health needs, severity of pain and other symptoms associated with the arthritis.
Read the entire Healthline article Managing Arthritis Pain
Meditation has long been touted as a holistic approach to pain relief. And studies show that long-time meditators can tolerate quite a bit of pain.
Now researchers at Wake Forest Baptist Medical Center have found you don't have to be a lifelong Buddhist monk to pull it off. Novices were able to tame pain after just a few training sessions.
Sounds a bit mystical, we know, but researchers using a special type of brain imaging were also able to see changes in the brain activity of newbies. Their conclusion? "A little over an hour of meditation training can dramatically reduce both the experience of pain and pain-related brain activation," Fadel Zeidan, a neuroscientist and the study's lead author, tells Shots. That finding's a first, Zeidan says.
Do you have a muscle, tendon or part of your body that is recurrently tight or painful and does not respond well to stretching? You may be a candidate for Active Release Techniques® (ART). ART is a fast-acting, highly effective soft tissue technique that breaks up adhesions or scar tissue, whether from trauma or repetitive strain, and helps return tissue to its normal flexibility and function.
Scar tissue can form with any type of repetitive motion that limits relaxation of the tissue thus restricting sufficient blood flow and oxygen to the area. An injured area where there is a chronic inflammation and insufficient flow of oxygen may trigger a series of chemical reactions called chemotaxis that increases the recruitment of macrophages and fibroblasts that eventually build fibrosis or scar formation. As an area becomes tighter and more fibrotic, the cycle is perpetuated and more scar formation occurs.
Acutely injured tissue tends to feel boggy and swollen, such as experienced with a sprain, strain or spasm. After a couple of weeks, tissue under the stress of sustained tightness or decreased mobility begins to change, becoming stringy, then lumpy, and eventually fibrotic. Fibrosis is what causes tendonitis to become chronic tendinosis. It is what can entrap nerves and cause someone to experience nerve pain with movement.
Whether scar tissue formed by repetitive motions working at the computer or by repetitive training for an elite musical or athletic performance or somewhere in between, an ART practitioner can identify where the adhesions are and then release them. Fibrotic tissue can be broken down, reabsorbed by the body, and with correct exercise and movement re-education, the tissue will remodel to do what it was designed to do, without recurrent pain or tightness.
Prior to the Vancouver Winter Olympics, I was working with Chuck Berkeley, a member of the USA Bobsled Team. He was experiencing recurrent calf pain and tightness that was keeping him from sprinting and jumping, two must-dos for his sport. Through specific palpation, adhesions were identified deep in his lateral calf, between the soleus and the peroneus longus. With significant tension placed on the adhesions and Chuck moving his ankle through motion first to stretch soleus and then peroneus longus, tension increased where my hand was and the adhesions were released. Within 3 treatments, his calf was no longer painful or tight. To restore the tissue to its normal function, Chuck was given specific exercises to strengthen his gluteal muscles, and avoid overuse of his calf muscles for stabilizing and push-off through his running stride and with jumping. His symptoms did not return, and Chuck was able to continue his training and compete in the Olympics.
P.R. “Nina” Patterson, PT, OCS, ART
Sports + Orthopedic Leaders Physical Therapy, Inc