Marcey E. Shapiro, MD

Fall Preparations

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When the fall is upon us, the office gets very busy this time of year. We would like to share a few seasonal suggestions that we hope you find helpful for maintaining optimal health. You may also want to look at our cold flu and protocols as well to stock your medicine cabinet.

•Stock up on bath salts, teas, supplements and medicines that you and/or your family members might need for the winter so that you have them on hand when they are needed. Below we are including our suggestions for immune strengthening and helpful remedies to have on hand in case of the onset of a cold or flu.

•If you like to garden, plant a winter garden of roots and greens, or plant garlic for harvest next summer. Sweet pea flowers planted now will get a good start and reward you with early color and lovely fragrance.

•Prepare your winter clothing and bed, this includes warmer bedding if you keep the house cool.

•Eliminate all sources of mold in your home.

•Make soups and freeze them or just stock up on your favorites.

•In the fall and winter months in our latitude, we cannot get enough UV light to make vitamin D from sunlight, even if we are outdoors a lot. So be sure to include plenty of Vitamin A and D rich foods, like cod liver oil, egg yolk ideally from pastured or free range chickens, and their free range livers. Vitamin D must be balanced with A for the body to utilize either appropriately.

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Cold & Flu Prevention Protocol

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To help prevent a flu/cold throughout the season you can use any or all of the following:

1. Homeopathic flu prevention. Influenzinum by Boiron (current year) 3 pellets daily for 2 weeks at the start of the flu season then once a week throughout the season. Or try Dolixol. Both are available at health food pharmacies.

2. • Immune strengthening herbs and mushrooms, which can include Chaga tea from chunks, host defense 2 daily or transfer factor multi immune two daily (if really run down two twice daily)
• Jade windscreen tablet 2 – 2x daily during the flu season
• Eat cooked shitake, enoki and/or maitake mushrooms regularly (at least twice a week)
• Take a mushroom tincture (like mycoforte or mycopotent immune) or tablets. Or use  
  Host Defense (by New Chapter) one cap twice a day or 30 drops a day of tincture.
• Drink Chaga Tea which is made from a firm fungus chunk - sold here at the office
• Elderberry tea, tincture or syrup

3. Colostrum  (IGg Protect) capsules 1 or 2 - twice daily

4. Take plenty of vitamin D with K2. Most adults need at least 2000iu per day of D and at least 90mg of K2, and many adults need quite a bit more for example 5000-10,000 iu per day is not uncommon. Doctor Shapiro is happy to order a vitamin D test if needed.Or for D and A, use Cod Liver Oil 1 teaspoon per 50lbs. body weightper day. If using out high vitamin cod liver oil (Blue Ice) use 1/2 teaspoon per 50 lbs. of body weight.  

5. Take zinc 30mg daily (Ideally test zinc level in blood first to assess need) . For a food source, nuts and oysters are both high in zinc

GENERAL PROTOCOL TO FOLLOW AT THE FIRST SIGN OF A FLU OR COLD

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At the very first sign of a flu or cold choose 3 or 4 of the following suggestions.  If you find that one method isn’t doing anything for you switch to another.

For a “cold” cold which means feeling chilled, copious clear mucous, no fever- warming herbs like ginger tea, turmeric and chai without the caffeine can really help. Garlic shots are good for either a “cold” cold or a “hot” cold

For a “hot” cold which means mild or low grade fever, maybe some body aches, yellowish thicker mucous, then use decongestant teas like mullein and elecampane tincture and a spoon of honey (if over 1 year old) to thin mucous and some apple cider vinegar in water.

1. Vitamin C 1000mg every 1-2 hours.  Decrease the frequency if you get an upset stomach or loose stools.)  Dr. Shapiro’s favorites are LypoSpheric C - 1 packet every 1-2 hours or liquid liposomal C from designs for health 1 teaspoon every 1-2 hours at first until feeling better.  (Liposomal C is much more well absorbed than capsules, Also, it is recommneded not to use a lot of buffered Vitamin C. If you prefer buffered, (which can be gentler on digestion) take no more than 5 1000mg capsules per day.

2.  Ossilococcinum homeopathic flu remedies.

3.  Mycelized Vitamin A  (do not take if you are pregnant or breast feeding)

Take 10 drops orally twice daily for 3 – 7 days.  Do not use this longer than 10 days per month even if the flu develops.

4.  Viracid 1-2 tablets 2-3 times a day. Don’t use if pregnant or breastfeeding. Viracid is available at our office.

5.  Yin Qiao tincture or tablets - Take 2 – 3 tabs every 3 – 4 hours for 2 days
    Or  1/2 teaspoon every 3 – 4 hours for 2 – 3 days

6.  Garlic “shots”

Finely chop one clove of garlic and put in a small cup.  Add juice of one whole lemon and  1/8- 1/4 teaspoon of cayenne pepper.  Drink it down fast! Chase with water if needed.  Do this 2 – 3 times per day for 1 – 2 days, or until your symptoms are gone.

7.  Add Congaplex (Standard process) 2 tablets 4 times daily

8. Zinc lozenges 2-3  times daily for a few days

9.  Chamomile tea or if congestion steam with chamomile essential oil blend (not for children under 5 or people allergic to chamomile)

10. Stay hydrated! Lots of teas, chicken or veggie broth.

11. REST!!!!

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If flu sets in, try the following:

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Viracid 1-2 tablets 2-3 times a day or Congaplex 2 tablets 4 times daily

Zinc lozenges one three times daily

Mycelized Vitamin A (see above)

Zhong Gan Ling tablets (follow dose on box) or tincture (1/2 tsp 4x/day)

Vitamin C 1000mg every 1-3 hours, liposomal is best

Quercetin 500mg twice daily or quercetin phytosome one twice daily

Or schedule for a visit and we will customize support for your symptomatic relief

We carry almost all of the above-mentioned products.  Some of them can be bought at local health food stores or pharmacies like Pharmaca.

If you need specific advice to address your particular symptoms, please schedule a visit by calling or emailing us at 510.525.2200 and office@marceyshapiromd.com

Try Dr Shapiro’s Family Chicken Soup Recipe

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Winter

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• The advent of winter usually arrives just after Thanksgiving.  Winter is the time for inner reflection, hibernating.  The exercise of winter is sleep, and a good season of it will ensure an energetic spring.  Let yourself sleep.

• In earlier eras before electric lights, people naturally slept much more in the winter. Nine to ten hours per night is just fine if you want that much.

• If you cannot exercise as much as you would like, find other ways to regularly sweat out the toxins like taking a sauna or a nice long bath. Make sure to stretch to keep your muscles and ligaments limber. Even 5-10 minutes a day can make a big difference in your health.

• The wind gates are the areas which the ancient Chinese noted are portals for “cold” to enter the body. They include the kidneys, head, neck and chest. Keep the wind gates covered when out of doors, especially if it is damp or windy.  Avoid getting chilled.

• Eat more warm and cooked foods and less cold and raw foods.  The body has to use more energy to stay warm, even more so if it has to warm up your food.  Broths are especially good at this time of year. Doctor Shapiro’s chicken soup recipe is included below.

• The digestive system tends to be more sluggish in the winter as people typically are less active.  Avoid overeating and be sure to stay hydrated.

• In the winter your body will love cooked dark greens such as kale and collards, and roots like carrots, turnips and parsnips every day. It will also appreciate more naturally fermented foods with live cultures such as miso and raw sauerkraut.  Warming teas such as chai and ginger are great this time of year. Less sugar and alcohol will also support your good health.

• Do something every day to make a deposit into the energy account of your body.  Anything that is nourishing to your nervous system such as yoga, meditation, bodywork, acupuncture, and creative endeavors will feed your energy account.

• Fun is essential. Do something fun and please, love and appreciate yourself and those around you every day! There is nothing better to support good health and well being than a positive outlook.

General Guidelines for Tea Making

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Leaf Teas

Amounts:  In general, you can use 1 tablespoon of leaf per 1 cup of water.
For Mullein and Red Clover, use 2 tablespoons per cup.

Instructions:

Boil water
Pour boiling water over tea.
Steep 20 minutes.
Strain and drink.

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Roots

Amounts: For roots, use 1 teaspoon of the root per 1 cup of water.

Instructions:

Boil water
Pour boiling water over tea.
Steep 30 to 45 minutes.  OR simmer in a covered pot for 10-15 minutes.
Strain and drink.

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Flowers

Flowers are the most delicate part of the plant and require the least amount of time to steep.
Amounts:  For flowers, use 1 tablespoon of flowers per 1 cup of water.

Instructions:

Boil water
Pour boiling water over tea.
Steep 5 minutes.
Strain and drink.

All teas need to be steeped in order to release the medicinal constituents of the herb.

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Spring Cleansing

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Welcome to the cheeping and buzzing of spring!!

The blustery cold, deep sleeps of the winter have passed for this year, and we are heading into another bountiful season.  Happy birds seem to be everywhere rejoicing in worms, early seeds and bugs aplenty. They are regaling us daily with their beautiful songs. Nest building and complicated courtships are earnestly underway.  Bees are emerging from the deep center of the hive, cleaning it out from winter debris.  Flowers are popping up here and there, readying for bee visitors, preparing to become fruit!

The cleansing foods and herbs of spring:

In Chinese medicine, spring is considered the liver’s time, and after a long sluggish winter it needs the foods and herbs that grow so abundantly at this time of year.  After the heavy and warming foods of winter, our bodies want and need lighter fare. Spring is a natural time for cleansing, both internally and externally.

So, bring on the greens!  Bitter is better, but any will help, and daily is best.  These help to invigorate the liver so it can better release the accumulated toxins and debris that can result in skin problems and digestive difficulties. Chickweed, Miner’s Lettuce, Lamb’s Quarters, Dandelion,  Milk Thistle, Arugula, mizuna, and tatsoi are good as well as other cleansing foods such as asparagus (kidneys), horseradish and beets (liver).  

Nettles are fantastic in the spring but must be cooked.  They can often be purchased at the farmer’s market, harvested in the wild, or bought dried. Picking them is an exercise in staying completely present, if you like that sort of thing. Even when buying them at the farmer’s market, be careful not to touch them with your hands or they will sting. Fresh nettles get their sting from the little hair like fibers that easily pierce the top layers of skin and release formic acid, causing redness and itching for up to 24 hours. These are completely broken down when cooked and dried. They are great as a medicinal spring tonic and can be prepared as tea, added to soups, or simply steamed and tossed with a bit of lemon juice and olive oil, or butter. Dr. Shapiro cooks them with a little rich bone broth (usually chicken), adding some fresh butter and a bit of sea salt.  Nettles are rich in calcium, carotenoids, chlorophyll, and are one of the best sources of digestible plant iron.  They have many medicinal uses and are widely used as a tonic all over the world. They are especially good for supporting healthy kidney function. Persons with a tendency to urinary tract infections, including pregnant women, could have a cup of nettle tea daily. The medicinal constituents of nettles are best extracted with water or when eaten as a vegetable, but a tincture can be used in a pinch.

Your environment:

Emotionally, spring is a great time to clear out mental clutter, and focus on what really brings us meaning in life. Cleaning your physical house is a great start to cleaning your mental and emotional houses… So, open the windows!  Shake out that rug!  Let that breeze clean out the house and infuse our homes with new life. Think about your belongings. If an item is not useful, beautiful, or meaningful to you, then it is probably ready to move on to a new home (or the trash).

It is also time to get the garden in.  Take off your shoes and feel the earth feeding your body with its energy.  Bask in that sunshine and fresh air and let the beauty of the season help you pace yourself.  Step gingerly into those projects you’ve been planning all winter.  Continue to get enough sleep and stay warm.  Be prepared when you leave the house that the weather could change.  Let the lengthening days and increasing warmth take you softly into the next season, allowing you to gather your strength as you go along with it.  That way, when summer arrives, you will be in full swing, healthy and fully in sync with the energy of the most productive season.

Some things to do in spring:  

• Plant a garden
• Clean the house
• Eat more raw foods, and greens every day
• Exercise more
• Consider, what can I do to make my nest work better for me?
• Clear out mental clutter, notice and let go of negative beliefs and “tapes” which no longer serve you.  
• Sing and appreciate life’s beauty like the birds.

Detoxing:

Dr. Shapiro frequently gets calls about cleansing and detox diets and programs, especially in the spring. These can often be supportive for people in good health, especially for people who are mostly well. But if you are weak, chronically ill, or convalescing, please discuss any detox plans with us or another practitioner before you undertake any program.  There are many ways to do detoxification, depending on which areas need to be addressed. Dr. Shapiro is happy to meet with you to discuss a custom program, or you can try one of these ideas on your own at home:

For cleansing and support of the liver, Dr. Shapiro loves this simple beverage:

1 whole organic lemon (including peel and seeds):  quarter lemon and put in blender with
1 Tablespoon extra virgin olive oil
and 1 cup water.

Blend at high speed together for 1-2 minutes. You will have a milky looking liquid. Feel free to strain out any chunks if you want. Drink this first thing in the morning (it is reasonably pleasant!)

The olive oil activates the liver, and supports bile flow.

The lemon peel, and (especially the pectins of) the lemon pulp, emulsifies fats, alkalinizes the body, and supports the liver and lymphatic system.

The lemon juice helps normalize body pH, and is mildly laxative.

Other Detox Ideas:

1. Homeopathic detox is one of Dr. Shapiro’s favorite approaches. We often advise a “Basic Detox Kit” from Pekana. This company makes outstanding spagyric remedies, which work not only physically, but gently support emotional cleansing as well.  The kit has 3 formulas, one each to support liver, kidneys and lymphatic detoxification. Dose can vary from person to person with as little as one drop of each bottle, to as much as 50 drops one to three times daily in water, away from food.

2. Cleanse using diet and herbal teas. We often advise a candida diet, and you can get an information sheet about Dr. Shapiro’s approach from the office. This cleanse eliminates sugar, sweets, fruit juice, dried fruits, wheat and gluten, and most, but not all dairy products. Whether or not you actually have candida, this is a nice cleanse which emphasizes fresh veggies, whole grains, free range meats and eggs, and healthy fats. Usually we advise the diet for a minimum of six weeks.

3. For those of you who prefer powder beverages, we have a number of medically designed detox products. We also have a good selection of organic green drinks, which can supplement any detox program, or just be used on their own for nutritional support.  But, of course, we’d most prefer for you to EAT the fruits and vegetables if you can.

4. You can enhance any cleanse by working with herbs.  A few basic ones are discussed below:      

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Dandelion root and leaves decongest the liver and assist the flow of bile. From a Chinese medicine perspective, dandelion cools “liver heat” which causes physical symptoms like gallstones, high blood pressure, and acid reflux, and emotional symptoms like irritability.

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Nettles, discussed above as a tea or capsules

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Milk Thistle protects, cleanses and nourishes both the liver and kidneys. It is best used as an extract of silymarin, as this is the medicinally active constituent. Silymarin accounts for only about 3% of the whole herb but 70-90% extractions of silymarin are widely available.  

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Red Root (ceonothus) as a tincture is great for supporting lymphatic and blood cleansing.

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Burdock Root, available as a vegetable (called gobo, in Japanese cuisine), tea, tincture, or capsule is great for assisting sluggish bowel function safely. It also is useful for clearing blood of heat and toxins, and supports the liver in flow of bile. Often used for skin rashes including eczema.

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Trifala, an ancient Ayurvedic combination of three fruits, is excellent and safe as a daily laxative and bowel toner.

5. Lymph drainage self massage, or lymph drainage massage by a practitioner. Normally lymph only flows at about two liters per day. This can be enhanced up to ten fold with lymph drainage techniques that allow the body to more easily clear accumulated toxins from intracellular spaces. Jumping rope, or using a rebounder are also quite helpful for lymphatic cleansing, as are saunas. Be sure to drink lots of water and have lots of fresh vegetables if you are doing any lymphatic cleansing.  

6. Avoid alcohol and drugs for ideal outcomes during any cleanses.

7. Fruit juice fasts put too much sugar into the system, and strain the adrenals. Dr. Shapiro does not recommend them.

8. Other types of metabolic detox and cleansing can be discussed individually in an appointment, if you prefer.

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On diet:

Dr. Shapiro feels the most healthful diet emphasizes fresh local foods. Just because we can get peaches year round doesn’t mean that they are ideal to eat year round. A lot of nutritive value is lost when foods are shipped long distances. For most of human history people ate what was in season and grown within a 100 mile or so radius of their homes. A few items, like spices, were traded over long distances, but most foods were local, and, of course, organic, because pesticides and herbicides did not exist even 100 years ago. We in the Bay area are extremely fortunate that we have so many year round resources for fresh seasonal local foods.

Generally, a local and seasonal diet is best for ourselves and the planet (not so much fossil fuels burned transporting out of season items hither and yon). Local organic foods are fresher and full of nutrients. Even meats that have been raised closer to home will be fresher, and minimize our carbon footprint.

Be sure your diet includes lots of foods with live cultures. Dr. Shapiro generally advises including foods like yogurt, raw milk cheeses, kefir, whey (unless you are allergic to dairy), and lacto-fermented foods such as raw sauerkraut, natural pickles, coconut kefir, kombucha, and live (unpastuerized) miso.

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Recipe for Staying Well:

It is common for imbalances to show themselves as the seasons change. These imbalances need not become illnesses, if we tune in to the needs of our bodies. This helps us to stay in balance and prevent illness. It is a good idea to visit your acupuncturist at least four times per year at seasonal changes for a “tune-up” to the new season. At seasonal changes, Dr.Shapiro can provide an acupuncture session for you if you wish, or a referral to one of the many wonderful local providers.

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Prayer of Gratitude

Thank you, earth, for the rains and the sweet darkness that helped me sleep deep into the dreamtime, nourishing my body and soul with rest.  Thank you for the winter soups, the candles, the soft warm blankets and my safe nest in which to snuggle with my loved ones, both two and four-leggeds.  thank you for the quiet, and the comfort of friends with the darkness got too long.  Now I am rested and ready to face a new season of more light and growth with the clarity and energy of a new morning.

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Allergies

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Spring is the beginning of pollen allergy season. First are the tree flowers, then the grasses. Some people have lots of allergies, others are allergic to only one or two things.

For general support with allergies, we have lots of advice. If  local seasonal pollens tend to bother you, see below. But, if seasonal allergies are more than a minor irritant, a deeper approach might be better. Feel free to make an appointment, if your allergies are long-standing or not resolving. Here are some pointers for resolving allergies:

1. Address adrenal fatigue. Many doctors, including Dr. Shapiro, have found that people suffering from significant allergies generally have some amount of adrenal fatigue. The doctor can test your adrenal function and prescribe appropriate supplements to support the glands. Things you can do on your own to support your adrenals include:

a. Avoid sugar and caffeine

b. Enjoy spicy teas like ginseng, cardamom, cinnamon, ginger, cloves, and licorice (best to avoid licorice if you have high blood pressure)

c. Get plenty of sleep

d. Practice meditation and cultivate a positive attitude

e. Avoid stress

f. Get plenty of B vitamins, either as nutritional yeast, in whole grains, or as a supplement. B5 is especially important for allergy sufferers. Dr. Shapiro prefers the activated form of B5 called Pantethine.

g. Consume more probiotics, either as supplements or foods or both. Probiotics are beneficial bacteria that live in our intestinal tracts and mucous membranes and support our health in many ways. For outstanding general probiotic supplements we recommend “Probiotic synergy” by Designs for Health (a powder) or Probiotic Pearls by Integrative Therapeutics, both require refrigeration. For a high power probiotic that does not require refrigeration, use Ortho Biotic, or for a basic one try Spectra Probiotic. All of these are available at our office. Commercially we like Natren Trinity best, and Jarrow Dophilus is okay for basic support.

2. For Symptomatic Relief: For many people with seasonal allergies, several simple remedies are helpful for controlling symptoms.

a. Neti Pot: A neti is an Ayurvedic tool for cleansing mucous and pollens from the nose. They can be purchased on line, and at many natural groceries and pharmacies. Many people find they get allergy relief from working with one. For basic Neti use, mix 1/2 teaspoon of sea salt with 1 cup of purified water. Pour this into one nostril, tilting your head to the other side, letting the fluid drain out the other nostril or into the back of the mouth. Spit out any liquid that gathers in the mouth. DO NOT snort the salt water up into your nose. If you find this irritating in any way, discontinue use of the neti.

b. Zone 9 drops are a homeopathic remedy made from pollens of this region. Try 10 drops under the tongue 2-3 times per day. Available at our office. Safe in pregnancy.

c. Natural d-Hist, is a supplement which helps control allergy symptoms. It has nothing in it to make you drowsy or wired, so is fine for driving, working and sleeping.  Use 2 capsules 2-3 times daily when symptoms are present. If possible, begin around 1-2 weeks before symptoms are expected. Available at our office.

d. Euphorbium Comp nasal spray is a homeopathic nasal spray that many of our patients rely on for relief of nasal allergy symptoms. Available at our office. Safe in pregnancy.

e. Quercetin, one component of Natural d-Hist, is popular for treating allergies. Use 500 mg 2-3 times daily.  If possible, begin around 1-2 weeks before symptoms are expected. Available many places (including our office)

f. XCLEAR^® is a nasal xylitol spray available in natural groceries in pharmacies (not at our office, though). It can decrease risk of sinus infections and help symptomatically with allergy relief.

g. Freeze dried nettle capsules are also part of Natural d-Hist and are often effective alone. They too, are widely available, both at our office and elsewhere. Safe in pregnancy.

h. Homeopathic remedies for grass pollen and tree pollen are easily found at natural food stores and natural pharmacies as well as our office. Safe in pregnancy.

i. Pantethine, or the activated form of vitamin B5, is helpful for many allergy sufferers. It also nourishes the adrenals, as discussed above. Use one or two tablets with breakfast and lunch. Safe in pregnancy.

j. Bian Pian and Pe Min Kan Wan are traditional Chinese herbal formulas for nasal allergies. There are a variety of different companies that make them, so follow directions on the bottle. I generally find Pe Min Kan Wan is best for the tree pollens and Bian Pian is best for the second part of the allergy season (grass pollens) but see for yourself. These are usually quite inexpensive and widely available.

Consider some of the other detoxification ideas and methods mentioned in Spring Cleansing.  The increased mucous that accompanies allergies may be the way that the body releases and moves out stored toxins and metabolic debris.  Of course, we have lots of other tools for a custom program if you need more than the above advice.

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Dry Brushings

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The skin is the largest organ of the body, and is important for elimination, excretion and detoxification. Generally, when we are healthy, each day about two pounds of sloughed cells and fluids exit our bodies via the skin.  The fluid secretions are found in perspiration and normal evaporation from skin. Healthy skin has a slightly acid pH, due to secretions by healthy normal flora that colonize it, as well as the acidity of our own secretions. This forms an acid barrier, called the acid mantle, that maintains skin integrity and protects skin. Despite our societies’ current obsession with anti-bacterial products, these products are not actually healthy for the skin, as they disrupt the protective acid mantle and actually leave us more vulnerable to infection and inflammation.

If soap is used at all, it should be gentle and emollient. Glycerin soaps, or those made with oils like olive oil, pure coconut oil or shea butter are acceptable when soap is needed. But usually soap is not actually required unless there is grease or grime on the skin. Water alone is sufficient for cleaning the skin most of the time.

Dry skin brushing can be utilized whether or not soap is used afterwards, but it can be an excellent alternative to washing with cleansers. Elimination and excretion from the skin can be supported and enhanced with this safe and gentle technique.

Dry skin brushing has a number of benefits:

• Skin and pores can become clogged with debris; these are gently removed and cleared with dry skin brushing without disturbing the acid mantle of the skin.

• Lymphatic circulation and drainage are enhanced with the technique. Much of our lymphatics are just below the skin, and good lymphatic flow means that wastes and toxins are more easily eliminated from our system.

• Over time, regularly brushed skin has a healthy rosy glow.

• Dry skin brushing enhances circulation.

• Dry skin brushing is easy! Even children can be taught to do it.

At first, when you begin dry skin brushing you may notice some skin sensitivity. This will decrease and resolve with continued treatments.

A sensible schedule for brushing is three times per week, before a shower. Less often is fine, and it is ok to do daily as well, if you shower daily.

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There are a few simple guidelines that will improve your experience and results.

1. Purchase a long handled natural bristle body brush. Synthetic brushes are not acceptable. Natural bristles can trap dirt, debris and oils, while synthetic brushes will just spread these around.
2. If face brushing is desired as well, get a separate, extra gentle natural bristle face brush.  But many people choose not to brush the face and that is ok too.
3. For the lower part of the body, including the abdomen, brush upwards, towards the heart.
4. Brush the abdomen first, then the groin, then the upper thighs, then knees and lower thighs, and then the feet.
5. Brush the lower part of the back the same way, upwards towards the heart
6. When brushing the chest, arms and upper back, brush towards the collarbone. Also brush the breasts towards the collarbone. The upper back should be brushed over the shoulder towards the collarbones.
7. Brush the neck toward the same side collarbone.
8. If the face is brushed, it goes towards the same side collarbone as well.
9. If desired, a natural bristle hairbrush can be used to brush the scalp, down towards the collarbone.

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