Core Medical & Wellness

Core Medical & Wellness Multi-disciplinary medical team specializing in non-surgical orthopedics, pain management, rheumatology, manual therapy and integrated wellness solutions.

Core Medical & Wellness are interventional pain management physicians specializing in the treatment of back pain, neck pain, knee pain, and other joint pain in a compassionate and caring environment. We use state of the art equipment and treatment techniques to reduce or eliminate your pain so that you may work and live as you desire.

Menopause pain is not aging.Your knees ache.Your fingers feel stiff in the morning.Your back hurts after sitting.You bla...
03/24/2026

Menopause pain is not aging.

Your knees ache.

Your fingers feel stiff in the morning.

Your back hurts after sitting.

You blame time.

More than half of women in perimenopause and menopause report joint and muscle pain.

Hormones drive much of it.

When estrogen drops, your body shifts:

🦴 Cartilage repair slows and joints lose cushioning
📉 Bone density drops and fracture risk rises
🔥 Inflammation rises as immune balance shifts
💪 Muscle mass falls and body fat rises, adding stress to hips and knees
🧠 Pain sensitivity rises as the nervous system processes signals

You feel it when:

✋ Your grip feels weak at wake up
🪜 Stairs strain your knees
🪑 Getting out of a chair hurts
😴 Poor sleep from hot flashes fuels next day pain

Sometimes X-rays show arthritis.

Sometimes scans look fine and pain stays.

Doctors call it arthralgia.

I see women in their 40s and 50s who trained, worked, raised families, and moved with ease.

Then periods slow.

Pain starts.

Old injuries flare.

Mild arthritis turns into daily pain.

Hormone replacement therapy plays a role in treatment for some women.

Estrogen supports cartilage, bone, muscle, and pain signaling.

Recent FDA label changes give clearer guidance for women who weigh this option.

HRT is not for everyone.

Pain care works best with a plan:

• Hormone evaluation
• Bone density screening
• Strength training to slow muscle loss
• Sleep support
• Anti-inflammatory nutrition

If your joints changed with your cycle, ask yourself:

Did pain rise when estrogen fell?

Your pain has a source.

Start there.

If you want help building a plan, book an appointment and talk through your options.

The “Wolverine stack” for pain?You’ve seen the name.BPC-157 + TB-500.Marketed for faster recovery.Shared in gym forums.T...
03/21/2026

The “Wolverine stack” for pain?

You’ve seen the name.

BPC-157 + TB-500.

Marketed for faster recovery.
Shared in gym forums.
Talked about in chronic pain groups.

So what does the research say?

Here’s what we know from preclinical studies.

🦴 BPC-157 supports tendon and ligament healing by increasing collagen synthesis
🩸 It promotes new blood vessel growth, which improves oxygen delivery to injured tissue
🔥 It reduces inflammatory signals like TNF-α and IL-6

TB-500 often gets paired with it for tissue repair and recovery support.

Together, people call this combo the “Wolverine stack.”

Why the hype?

Because chronic pain often involves:

• Poor blood flow
• Ongoing inflammation
• Slow soft tissue healing

Address those three, and recovery shifts.

But here’s the part most posts skip.

Large human trials are still lacking.

Long-term safety data in humans remains limited.

From 2023 to 2026, FDA peptide regulation shifted.

Earlier restrictions limited compounding access.

Under the 2026 framework, licensed pharmacies can compound peptides like BPC-157 and TB-500 again with a doctor’s prescription.

Access changed.

The evidence base did not suddenly expand.

If you live with chronic pain, ask yourself:

Are you chasing trends?

Or are you building a plan based on data, medical guidance, and long-term outcomes?

Pain management works best when you:

✅ Understand the mechanism
✅ Review the research
✅ Talk with a qualified physician
✅ Track outcomes over time

Quick fixes attract attention.

Sustained recovery requires strategy.

Before you try the next stack, have the hard conversation with your doctor.

Your joints, spine, and future mobility depend on it.

Your back pain needs more pills?If your lower back hurts most days for over 3 months, doctors call it chronic low back p...
03/17/2026

Your back pain needs more pills?

If your lower back hurts most days for over 3 months, doctors call it chronic low back pain.

You feel it when you:

🪑 Sit at your desk
🛏️ Try to sleep
🧒 Pick up your kids
🚶 Stand or walk for long

This type of pain affects millions of adults each year.

It limits work.

It cuts into family time.

It drains your mood.

Many people think shots or medication are the only answers.

They are not the only tools.

Research shows movement and mind–body care improve long-term back pain.

At our clinic, we use three approaches alongside medical care:

🧘 Yoga
- Builds strength around your spine
- Improves flexibility
- Uses breathing to lower stress

🤸 Pilates
- Targets core muscles
- Trains posture
- Focuses on controlled movement

📍 Acupuncture
- Stimulates specific points
- Reduces pain signals
- Eases muscle tension

Why does this matter?

Your lower back supports you all day.

When muscles grow weak and posture slips, your spine loses support.

Stress adds fuel to the fire. It increases how intense pain feels.

Stronger muscles support your spine.

Better balance reduces strain.

Lower stress decreases pain sensitivity.

Patients who pair these therapies with physical therapy, better sleep, and healthy weight see steady progress.

Not overnight.

But week by week.

What would change in your life if sitting through dinner felt easy again?

If sleep came without back pain waking you up?

You have more options than you think.

Which one will you try first?

https://coremedicalwellness.com/chronic-low-back-pain-yoga-pilates-acupuncture/

Chronic pain is not only wear and tear.You feel it in your back.  Your neck.  Your joints.  So you treat the spot that h...
03/13/2026

Chronic pain is not only wear and tear.

You feel it in your back.
Your neck.
Your joints.

So you treat the spot that hurts.

But what if the issue starts inside your cells?

Every cell in your body runs on energy.

That energy depends on one molecule: NAD+.

When NAD+ drops, problems rise:

⚡ Low cellular energy
🔥 Higher inflammation
🧠 Slower nerve repair
💥 Increased pain sensitivity

Chronic pain involves:

• Your nerves
• Your immune system
• Your mitochondria, the energy factories in your cells

NAD+ sits at the center of all three.

Here is what research shows.

When NAD+ levels stay high:

✅ Mitochondria produce more ATP, the fuel your cells use
✅ Sirtuins switch down inflammatory pathways like NF-kB
✅ Injured nerves resist breakdown
✅ Axons stay protected

In lab models of chemotherapy-induced neuropathy, supporting the NAD+ salvage pathway protected the sciatic nerve and reduced pain behavior.

Some small clinical reports show people with fibromyalgia report less pain, less fatigue, and clearer thinking after NAD+ infusions.

A small trial in chronic fatigue syndrome showed modest improvement in body pain scores with NADH supplements.

Large human trials for pain are still limited.

But the biology makes sense.

If your pain links to low cellular energy and ongoing inflammation, supporting the molecule that drives energy production matters.

There are two main ways people raise NAD+:

💊 Oral precursors like NR and NMN
• Shown to raise NAD+ levels
• Strong safety data
• Reduce inflammatory markers

💉 IV NAD+ therapy
• Delivers NAD+ into the bloodstream
• Patients report better energy and reduced pain
• No standardized dosing yet

Joint pain adds another layer.

NAD+ supports cartilage health.
It reduces oxidative stress.
It supports tissue repair.

Some regenerative medicine doctors pair NAD+ support with PRP or stem cell therapy to address both structure and metabolism.

Ask yourself:

Are you only treating the symptom?

Or are you supporting the energy system inside your cells?

Pain management is shifting.

Not only blocking pain signals.

But supporting how your cells produce energy, repair tissue, and control inflammation.

If your body runs on energy, what happens when you restore the fuel supply?

Your back pain might start in your gutWhen you think about chronic pain, you think about joints, discs, muscles.Not your...
03/10/2026

Your back pain might start in your gut

When you think about chronic pain, you think about joints, discs, muscles.

Not your stomach.

Yet your gut holds trillions of bacteria.

They regulate your immune system.
They produce vitamins.
They talk to your brain through the vagus nerve.

When this system stays balanced, you feel steady.

When it shifts out of balance, problems begin.

Here’s what happens:

🦠 Harmful bacteria overgrow
🔥 Your immune system stays switched on
🧠 Inflammatory signals reach your nervous system
⚡ Nerves become sensitive
📍 Mild pressure starts to feel like pain

This is one driver behind widespread pain and central sensitization.

Let’s talk about “leaky gut.”

Your gut lining works like a fine mesh screen.

It lets nutrients pass.
It blocks bacteria and toxins.

When the tight junctions loosen:

🚪 Bacterial fragments enter your bloodstream
🚨 Your immune system reacts
🔥 Low-grade inflammation builds
📈 Pain levels rise

Research in people with fibromyalgia and chronic fatigue shows higher markers of gut permeability.

Those with worse gut leakiness report worse symptoms.

This means your back pain, neck pain, or joint pain might link to your gut health.

Not only to posture.
Not only to aging.
Not only to wear and tear.

If you live with chronic pain, ask yourself:

• Do you deal with bloating or irregular digestion?
• Did your pain start after illness or stress?
• Do flare-ups follow poor sleep or diet changes?

Your gut and brain stay in constant communication.

Through the vagus nerve, signals move both ways.

Calm gut.
Calmer nervous system.

Chronic pain treatment needs a wider lens.

Look beyond the site of pain.

Look at inflammation.
Look at the microbiome.
Look at the gut-brain link.

Your stomach might hold answers your MRI did not show.

Creatine isn’t only for bodybuildersMost people see a gym supplement.Athletes.Protein shakers.College weight rooms.They ...
03/06/2026

Creatine isn’t only for bodybuilders

Most people see a gym supplement.

Athletes.
Protein shakers.
College weight rooms.

They miss what the research shows.

Creatine is one of the most studied compounds in sports medicine.

And doctors now use it in pain and rehab settings.

Here’s why.

Your muscles and brain store creatine as phosphocreatine.

Phosphocreatine helps your body produce ATP.

ATP fuels every cell you have.

When pain becomes chronic, several things often happen:

🔋 Low cellular energy in muscle and nerve tissue
🔥 Ongoing low-grade inflammation
🪫 Poor exercise tolerance
📉 Muscle loss and deconditioning

Creatine supports the energy system behind all of this.

It does not block pain signals like an opioid.

It supports the environment where tissues repair and respond to rehab.

That difference matters.

Research shows creatine:

🧪 Reduces inflammatory markers in lab models
🧠 Supports mitochondrial function under stress
💪 Improves strength and lean mass during rehab
🏃 Increases exercise capacity in fatigued patients

Let’s look at fibromyalgia.

A 16-week randomized controlled trial found:

• Higher intramuscular energy stores
• Better upper and lower body strength
• Improved physical function
• Modest pain reduction

In another study, patients reported:

• Better sleep
• Lower disease severity
• Improved daily function

When they stopped creatine, improvements faded within four weeks.

Ongoing use mattered.

Now think about joint pain.

Knee osteoarthritis often involves weak muscles around the joint.

Weak muscles increase joint load.

Increased load drives pain.

Studies show resistance training plus creatine leads to:

🦵 Greater lower body strength
🚶 Faster walking speed
🪑 Better chair rise performance
📈 More lean mass

Stronger muscles improve joint mechanics.

Improved mechanics reduce stress on the joint.

Less stress often means less pain.

In post-surgical rehab, creatine helps patients:

🛌 Preserve muscle during immobilization
🏋️ Recover strength earlier
😓 Reduce fatigue during therapy

That helps people stay consistent with rehab.

And consistency drives results.

What about safety?

Creatine monohydrate is the most studied form.

Standard dose: 3 to 5 grams per day.

No need for complex protocols.

Large reviews show:

• Small rise in serum creatinine
• No drop in kidney filtration in healthy adults

For people with normal kidney function, data supports safety at standard doses.

Hydration matters.

Medical oversight matters.

Who benefits most?

✅ Fibromyalgia with fatigue
✅ Chronic joint pain while strength training
✅ Post-surgical rehab
✅ Chronic low back pain with weakness
✅ Active adults with recurring injuries

Creatine works best inside a larger plan:

• Progressive strength training
• Sleep improvement
• Anti-inflammatory nutrition
• Targeted pain procedures when needed

It supports your effort.

It helps your muscles respond to the work you put in.

If you live with chronic pain, ask yourself:

Is weakness part of your problem?
Do you fatigue fast in therapy?
Do you struggle to rebuild strength?

If yes, this conversation is worth having.

Creatine is not a magic fix.

It is cellular energy support.

And for many people in pain, energy is the missing piece.

Your knee pain is not random.If you live with back or knee pain, you know this cycle:🔥 Pain limits movement  ⚖️ Less mov...
03/03/2026

Your knee pain is not random.

If you live with back or knee pain, you know this cycle:

🔥 Pain limits movement
⚖️ Less movement leads to weight gain
🦴 Extra weight increases joint stress
🔁 Pain gets worse

For years, treatment focused on symptoms.

Pain pills.
Injections.
Physical therapy.
Surgery.

These tools help.

But they do not address two drivers of chronic joint and spine pain:

• Excess body weight
• Chronic inflammation from metabolic dysfunction

GLP-1 medications are changing this.

Semaglutide.
Tirzepatide.
Retatrutide in clinical trials.

These drugs mimic a gut hormone released after you eat.

They:

✅ Reduce appetite
✅ Improve blood sugar control
✅ Increase fat loss over time

The impact on joints is direct.

Every extra pound of body weight adds several pounds of force across your knees and lower back with each step.

In a large study, patients with obesity and knee osteoarthritis who used weekly semaglutide lost about 14 percent of body weight over 68 weeks.

They reported:

🦵 Less knee pain
🚶 Greater walking distance
📉 Improved function scores

Retatrutide trials show weight loss near 23 to 24 percent in 48 weeks.

In one knee osteoarthritis study arm, participants lost around 70 pounds on average and saw knee pain scores drop by up to 75 percent.

This is not a painkiller.

It reduces:

• Mechanical overload on joints
• Inflammatory chemicals such as IL-6 and IL-1 beta

Less load.
Less inflammation.
Better movement.

There is a catch.

Up to one-third of weight lost on GLP-1 therapy may come from lean mass.

Without resistance training and protein intake, you lose muscle and bone along with fat.

In one trial, patients who used medication alone lost hip and spine bone density.

Those who trained with weights preserved muscle and bone.

Medication alone is not the plan.

The model looks like this:

1️⃣ Medical weight loss to reduce load and inflammation
2️⃣ Targeted pain treatment for discs, facets, or knees
3️⃣ Strength training 2 to 4 times per week
4️⃣ Ongoing body composition tracking

One patient with knee osteoarthritis who lost over 20 percent of body weight, completed a quadriceps program, and received targeted injections delayed knee replacement and returned to daily walks without stopping every block.

Pain is not always a joint problem alone.

It is often a load and inflammation problem.

If you struggle with chronic pain and excess weight, ask yourself:

Are you treating symptoms only?
Or are you addressing the drivers behind them?

Your back pain isn’t aging.You used to jump out of bed.Now your lower back aches.It stiffens after your desk job.It flar...
02/24/2026

Your back pain isn’t aging.

You used to jump out of bed.

Now your lower back aches.
It stiffens after your desk job.
It flares after golf.
It protests after a run.

You tell yourself it’s “normal.”

For many adults in their 40s, 50s, and 60s, there’s a name for it:

Degenerative Disc Disease.

Despite the word “disease,” it’s not a disease.

It’s wear and tear on the discs between your vertebrae.

Think about your spinal discs like shock absorbers.

When they’re healthy:
• They hold fluid
• They stay flexible
• They absorb load when you bend and lift

Over time, they:
• Lose water
• Thin out
• Crack or bulge

The result?

• 🔥 Deep, aching lower back pain
• 🪑 Pain worse with sitting
• 🌅 Morning stiffness
• ⚡ Pain into hips, buttocks, or legs
• 🚶 Relief when you walk or change position

Here’s what surprises most people:

Many adults show disc degeneration on MRI and feel no pain.

Your scan does not tell the whole story.

Your muscle strength.
Your posture.
Your nerve sensitivity.
Your daily habits.

They matter as much as the disc.

What speeds disc breakdown?

• 🧬 Genetics
• 🏋️ Years of heavy lifting
• 💻 Sitting 8+ hours a day
• 🚬 Smoking
• ⚖️ Extra body weight
• 🚗 Old injuries you brushed off

You don’t need surgery in most cases.

Most people improve with:

• 🧠 A clear diagnosis
• 🏋️ Core and hip strengthening
• 🔁 Smarter movement patterns
• 🪑 Better workstation setup
• 🚶 Staying active instead of bed rest
• 💊 Short-term anti-inflammatory support during flares

When nerve pain shoots down your leg, targeted injections placed under X-ray guidance reduce inflammation and calm irritated nerves.

Precision matters.

There is no one plan for every spine.

Flare-ups will happen.

What matters is your response.

Do you rest for weeks?
Or follow a plan and keep moving?

You don’t need to give up running.
You don’t need to stop lifting.
You don’t need to accept daily pain.

You need the right evaluation.
The right strength plan.
The right guidance.

How long have you blamed your age for something treatable?

Stop Guessing: Heat Or Ice?You wake up with back pain.Or your knee swells after a long day.So you grab a heating pad.Or ...
02/20/2026

Stop Guessing: Heat Or Ice?

You wake up with back pain.

Or your knee swells after a long day.

So you grab a heating pad.

Or an ice pack.

But which one is right?

Here’s the simple rule I give my patients:

🔥 New, hot, swollen pain → Use ice
🔥 Old, stiff, achy pain → Use heat
🔥 Not sure → Use the one that helps you move better

That’s it.

Let’s break it down.

When Ice Wins

Ice works best when pain is fresh.

Think:

🧊 You tweaked your back lifting something
🧊 Your knee looks puffy after activity
🧊 The area feels warm or throbbing

Cold slows blood flow.

It reduces swelling.

It numbs sharp pain.

Use it 10–20 minutes.

Always wrap it in a towel.

Never fall asleep on it.

When Heat Wins

Heat works best for stiffness and tight muscles.

Think:

🔥 Morning arthritis stiffness
🔥 Chronic low back pain
🔥 Tight neck and shoulders after sitting

Heat increases blood flow.

It relaxes muscle.

It loosens joints.

Use it 15–30 minutes.

Place a cloth between your skin and the heat.

Never sleep on a heating pad.

Back Pain?

First 48–72 hours after a strain → ice.

Ongoing tight, stiff back → heat before walking or stretching.

Your goal is simple.

Move more comfortably.

Arthritis?

Morning stiffness → heat.

Swollen flare after a busy day → ice.

Your joint tells you what it needs.

Listen to it.

One more thing.

Heat and ice help symptoms.

They do not fix the cause.

If pain:

• Limits your daily activity
• Stops you from exercising
• Keeps getting worse
• Comes with weakness or numbness

You need more than a heating pad.

So ask yourself:

Are you treating the symptom…

Or solving the problem?

Your back pain needs heatChronic low back pain.Morning joint stiffness.Arthritis flares.You’ve tried stretches, pills, n...
02/17/2026

Your back pain needs heat

Chronic low back pain.

Morning joint stiffness.

Arthritis flares.

You’ve tried stretches, pills, new chairs.

What if 15 minutes of heat, 3 times a week, changed your pain score?

Here’s what happens inside your body during a sauna session:

🔥 Muscles relax and stop guarding your spine
🩸 Blood flow increases to stiff joints and sore tissue
🧠 Endorphins rise and lift your pain threshold
🛡️ Anti-inflammatory signals like IL-6 and IL-10 increase over time
⚡ Your nervous system dials down pain amplification

Clinical trials show:

• 10 to 20 minutes per session
• 2 to 4 times per week
• 4 to 6 weeks of consistent use

Result?

Lower pain scores.

Better mobility.

Improved daily function on tools like the Oswestry Disability Index.

Not all heat works the same.

Traditional dry sauna
70 to 100°C
Strong data for mechanical low back pain
Best before mobility or stretching

Infrared sauna
45 to 65°C
Lower ambient heat
Strong results for rheumatoid arthritis, ankylosing spondylitis, fibromyalgia
Often easier to tolerate

Steam room
40 to 50°C with high humidity
Good for short-term muscle relaxation
Less evidence for long-term pain change

This is not a replacement for strength training, sleep, or medical care.

It supports them.

Many people report:

• Less morning stiffness
• Easier walking
• Longer standing tolerance
• Better sleep on sauna days

Track your pain from 0 to 10.

Track how long you stand or walk.

Do this for 6 weeks.

See what changes.

If chronic back or joint pain limits your life, add structured heat to your plan.

Would you commit 15 minutes, three times a week, to test it?

Weekend workouts are hurting you.You sit all week.Then you go hard on Saturday.Pickup basketball. Long run. Jiu-jitsu op...
02/13/2026

Weekend workouts are hurting you.

You sit all week.

Then you go hard on Saturday.

Pickup basketball. Long run. Jiu-jitsu open mat.

By Monday your body protests.

• 🏀 Sore back
• 🦵 Tight hamstrings
• 🦴 Achy knees
• 😴 Low energy
• 🚑 Sometimes a real injury

Millions of recreational athletes live this cycle.

Enthusiasm.

Then stiffness.

Then time off.

Here is the truth.

Weekend warrior injury prevention does not require pro-level training.

It requires smart habits.

Dr. Richard Kang, double board-certified in anesthesiology and fellowship-trained in interventional pain management, sees this pattern every week.

He also trains in jiu-jitsu.

He knows the aches firsthand.

Here is what works.

• 🔥 Warm up like an athlete
Spend 5 to 10 minutes raising your heart rate. Move your hips, shoulders, and spine. Cold muscles tear.

• 🏋️ Strength train midweek
Two short sessions build joint stability. Strong glutes and core protect your back and knees.

• 😴 Sleep 7 to 9 hours
Research in sports medicine journals links sleep to faster muscle repair and fewer injuries.

• 🍳 Eat to recover
Protein after training supports muscle repair. Carbs refill glycogen. Skip the junk binge.

• 🚶 Active recovery beats the couch
Light walking or mobility work reduces stiffness more than total rest.

• 👟 Check your gear and surface
Worn shoes and hard courts raise injury risk.

• ⏳ Respect age and recovery windows
Recovery slows in your 40s and 50s. Plan rest days.

• ⚠️ Listen to early warning signs
Nagging pain is data. Address it before it becomes a tear.

A simple weekly framework:

Lift twice.

Condition once.

Play hard once.

Recover on purpose.

You do not need to stop doing what you love.

You need to train in a way your body can sustain.

Are you training for Saturday only.

Or are you training for the next 20 years.

Is “just getting older” your doctor’s only answer?Tired all the time.Brain fog at work.Mood swings for no reason.Less mo...
10/21/2025

Is “just getting older” your doctor’s only answer?

Tired all the time.

Brain fog at work.

Mood swings for no reason.

Less motivation. Less muscle. More fat.

Lower s*x drive, even with nothing else wrong.

These aren’t random symptoms.

They’re signs of something specific:

🧪 Declining testosterone levels
📉 Dropping DHEA and growth hormone
⚖️ Cortisol imbalances from long-term stress
😴 Poor sleep quality or disrupted circadian rhythm
🍽️ Slower metabolism and changing nutrient needs

You don’t have to live with it.

Most men over 35 start to feel “off,” but blame work, aging, or diet.

So they power through until things get worse.

What actually works?

Basic labs to identify hormonal imbalances.

Targeted treatment—bioidentical hormone therapy, lifestyle changes, and nutritional strategies.

Men in our practice report:

🏃‍♂️ More energy and focus
😌 Better mood and patience
💪 Muscle gain with less effort
🔥 Increased s*x drive and performance
🌙 Deeper, more restful sleep

Still think it's “just aging”?

We’ve helped thousands feel like themselves again—with evidence-based care and zero guesswork.

Want to learn what’s really happening in your body?
https://coremedicalwellness.com/male-hormonal-changes-guide/

Click here to book a consult at Core Medical & Wellness: 888-521-0688

Our doctors listen, act fast, and treat you like family.

Address

256 Stuyvesant Avenue
Lyndhurst, NJ
07071

Opening Hours

Monday 9am - 5pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm
Friday 9am - 5pm
Saturday 9am - 5pm

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CORE Medical & Wellness

CORE Medical & Wellness is the new driving force in delivering meaningful healthcare to everyone who walks through our doors. We know there are strong links between your body and spirit and we seek to help you nurture both. We do this by looking at the total person and not simply through the narrow lens of a disease and condition. We look forward to showing you how our total approach to health,and wellness can help you live a more active and satisfying lifestyle.

Our Promise is to provide exceptional medical care by treating you as a person first, not just a patient. We aim to help you achieve your best health by focusing on your individual needs.

Our Core Values encompasses:


  • Passion - We believe that our passion is the fuel that energizes us and keeps us engaged with fulfilling our purpose. Our purpose is to meet -and exceed- the expectations of all our patients.