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Asthma, what to do?

Hi John,
Our 13 year old son who suffers from reactive airway disease (aka asthma) and allergies (to dust mites and cats). He has suffered from these conditions for 7 years, and continues with traditional pharmaceutical medication treatment. We have made many environmental changes in our home to reduce allergens. Our son has also seen a homeopath in the past, but with little obvious effect. You come recommended to us, and we are interested in whether you can provide an alternative to steroid treatment and other medications that reduce nasal decongestion.
– Dr. P.

Dear Dr. P,
The younger the child, the easier it is to treat asthmatic conditions.  About 90% of the 4 year old and younger patients have been able to get completely off of medications.  The condition at that age is usually very simple and uncomplicated.  The older the patient the (generally) more difficult it is to get great results.

At age 13 with reactive airway, after 7 years of steroids, I would guess about 50% likelihood of success.  One of the biggest reasons for the much lower rate of success is that the steroids shut down the bodies endogenous corticosteroids so that when the patient is taken off of them, there is no systemic way for the body to put out the fire.

Chinese Medicine works by increasing the endogenous corticosteroid levels.  It takes time to reawaken this corticosteroid system after 7 years of suppression.  There is good experimental information on this issue that was reported in a study done at Mount Sinai Hospital.

Mount Sinai Research Abstract except:
1: J Allergy Clin Immunol. 2005 Sep;116(3):517-24
Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma.
Wen MC, Wei CH, Hu ZQ, Srivastava K, Ko J, Xi ST, Mu DZ, Du JB, Li GH, Wallenstein S, Sampson H, Kattan M, Li XM. Weifang Asthma Hospital, Shandong, China

BACKGROUND: Chinese herbal medicine has a long history of human use. A novel herbal formula, anti-asthma herbal medicine intervention (ASHMI), has been shown to be an effective therapy in a murine model of allergic asthma. OBJECTIVE: This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy.

METHODS: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks. Spirometry measurements; symptom scores; side effects; and serum cortisol, cytokine, and IgE levels were evaluated before and after treatment.

RESULTS: Posttreatment lung function was significantly improved in both groups as shown by increased FEV(1) and peak expiratory flow findings (P<.001). The improvement was slightly but significantly greater in the prednisone group (P<.05). Clinical symptom scores, use of beta(2)-bronchodilators, and serum IgE levels were reduced significantly, and to a similar degree in both groups (P<.001). T(H)2 cytokine levels were significantly reduced in both treated groups (P<.001) and were lower in the prednisone-treated group (P<.05). Serum IFN-gamma and cortisol levels were significantly decreased in the prednisone group (P<.001) but significantly increased in the ASHMI group (P<.001). No severe side effects were observed in either group.

CONCLUSION: Anti-asthma herbal medicine intervention appears to be a safe and effective alternative medicine for treating asthma. In contrast with prednisone, ASHMI had no adverse effect on adrenal function and had a beneficial effect on T(H)1 and T(H)2 balance.

There is a great deal more relevant information in the actual report than in this abstract. The really important findings, to me, of this study are the ones underlined above.  Other studies have also shown that, likely as a result of the dramatic difference in the levels of immune complement in Steroid vs. herbs, there was a near 100% relapse rate after the steroids and a low relapse rate after herbs.  The suppressed immune system on steroids virtually guarantees recurrence. There are many other studies to support this effect.

With the numerous problems with the steroids, including the significant suppression of endogenous corticosteroids, I would recommend trying Chinese Medicine for the condition.

I am known as a minimalist in the number of treatments that I do .  Typically about 1/4 of the treatments of most acupuncture practices.  I focus a great deal on diet, supplements, herbs, lifestyle, so don’t need as many acupuncture visits.

– Dr. John Nieters, L.Ac. DAOM, FABORM

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April 2011 Revitalize your health with acupuncture

In This Issue (Get QiMail delivered to your inbox )
– Revitalize Your Health with Acupuncture and Nutrition
– Acupuncture for Weight Loss
– Step into Wellness
– Blueberry-Lemon Sorbet

Revitalize Your Health with Acupuncture and Nutrition
Preventive medicine is defined as the part of medicine engaged with preventing disease rather than curing it. An integral part of preventative medicine, nutrition is considered the first line of defense in acupuncture and Oriental medicine as it provides the energy needed for the body to function. Good nutrition not only provides energy, it also provides the basic building blocks, vitamins, minerals, phytochemicals and antioxidents that keep the body healthy and vibrant. 

A nutritional imbalance in foods consumed contributes to an imbalance in overall health. Eating an unnatural and restrictive diet can lead to yo-yo dieting and drastic ups and downs in body weight. Improper diet practises can cause malnutrition, organ damage, slow metabolic rate and other imbalances within the body. Biochemical and energetic imbalances may present themselves as pain, sleep disturbances, mood changes, abnormal digestion, headaches and menstrual irregularities.

Through the process of evaluating subtle physical signs as well as the emotional condition of a person, practitioners of acupuncture and Oriental medicine can detect health problems in their earliest stages, before a grave illness develops. Once the imbalance has been determined, a customized program can be created with a variety of treatment modalities including acupuncture, herbal therapy, tui na, qi gong in addition to food, exercise and lifestlye suggestions

Seasonal acupuncture treatments just four times a year serve to tonify the inner organ systems and correct minor annoyances before they become serious problems. 

Call today to see how acupuncture and Oriental medicine can revitalize your health!

Acupuncture for Weight Loss
In Oriental medicine the root of excess weight is an imbalance within the body caused by malfunctioning of the spleen and liver organ systems. Acupuncture points, foods and herbs selected to assist with weight loss directly influence the Qi of the spleen and liver systems to treat the imbalances causing the weight gain.

The spleen is responsible for the proper functioning of the digestive system, ensuring that the food we eat is transformed into Qi, the vital substance of life. Disharmony of the spleen will have symptoms such as fatigue, slow metabolism, water retention, loose stool, and feeling of heaviness. 

The liver’s job is to keep the flow of your body’s Qi, blood and emotions running smoothly. Our modern, fast-paced lifestyle and chronic stress can negatively impact the liver’s ability to function properly and smoothly, which, in turn, can cause the spleen and the whole digestive system to function poorly and decrease your metabolism. Liver disharmony can also cause some of the “triggers” that lead to cravings and compulsive eating. 

Acupuncture and Oriental medicine has been shown to have an effect on the functioning of the nervous, endocrine and digestive systems, food cravings, and metabolism. These functions all help energize the body, maximize the absorption of nutrients, regulate elimination, control overeating, suppress the appetite, and reduce anxiety. 

A Total Health Program
Acupuncture and Oriental medicine address the issues of over-eating and low metabolism with effective tools to control appetite and increase energy. Energetic imbalances are corrected and the digestive and elimination processes are improved so that there is a physical shift in the body to naturally have more energy and desire less food. By addressing both the physiological and psychological aspects of weight loss acupuncture and Oriental medicine provide a comprehensive therapy for weight issues that promotes better digestion, smooths emotions, reduces appetite, improves metabolism, and eliminates food cravings. 

Each treatment is catered to the needs of the individual patient. Acupuncture points on the body are chosen for overall well being with the objective of increasing circulation of the blood and Qi (stimulating the metabolism) and calming the nervous system. Treatments can include a combination of auricular (ear) and body acupuncture, ear tacks or pellets to leave on in-between treatments, herbs and supplements, abdominal massage, breathing exercises, and food and lifestyle recommendations.

In addition to treating the root of the imbalance within the body, different acupuncture points may be chosen for each treatment as different symptoms arise. For instance, if you are experiencing a desire to overeat related to premenstrual syndrome (PMS) one week, then that can be addressed at that week’s appointment.

The herbs and foods that are chosen during a weight loss treatment are for promoting healthy digestion, energizing the body, augmenting Qi, and improve elimination of water, toxins, and waste products. Most patients report a marked decline in appetite and cravings with acupuncture alone but herbs, healing foods, and exercises can definitely enhance the efficacy of the treatments.

Come in for a consultation to see how acupuncture and Oriental medicine can assist you with your weight management goals and help you to live a long, healthy life!

Step into Wellness
One of the many ways that walking can promote health and wellness is by putting gentle pressure on Yongquan (Bubbling Spring), an acupuncture point on the sole of the foot. 

In Oriental health theory, this is the starting point of the Kidney meridian and stimulation of this energizing point can promote clarity of the mind and stabilize emotions.

Yongquan is located in the depression on the sole of the foot at the junction of the anterior third and the posterior two thirds of the sole. 

The acupuncture point, Yongquan, has been found to benefit high blood pressure, stress, insomnia, headaches, sexual potency, and kidney function.

To Stimulate Yongquan: 

While Walking:
* Let your heel tap the ground gently
* Feel your weight transfer fully to the ball and toes of your foot.
* Focus on breathing into your lower abdomen
* Keep your shoulders relaxed and allow your arms to swing freely

By Tapping: 
Use your fists to strike your Yongquan about 100 times on each foot. 

By Rolling: 
Gently roll a tennis ball under your foot while relaxing on the couch.

Blueberry-Lemon Sorbet
A healthy antioxidant rich treat at only 77 calories per 1/2 cup serving.

3 cups blueberries
1/2 cup water
2 T honey
1 t lemon zest
2 T fresh lemon juice
1/8 t salt

Place all ingredients in a blender and process until smooth. 
Pour into a freezer safe container.
Freeze 1 hour or until hard.
Let stand 10 minutes before serving.

News and Events
Thanks to everyone in our community for your support. Thank you for the honor! SF BayList, 190 nominees, 934 votes. John received 2nd place. Your votes and comments are a wonderful gift. Thank you!

Thanks to everyone who reached out to wish John a Happy Birthday this March.

We will always accommodate established patients for urgent care drop-in visits during business hours.

Tune-in to The Medicine Men and The Balancing Point radio shows
Podcast in iTunes, or live in the Bay Area, www.medicinemenradio.com or www.thebalancingpoint.net

April 30th at 6pm, at the New Living Expo, John will present an Integrative Approach to Preventing Dementia and Alzheimer’s. www.newlivingexpo.com

April 29-May 1 Sat. & Sun. 2-3:30pm John will offer two presentations at the World Congress on Qigong & TCM. San Francisco at the historic Hotel Whitcomb. www.eastwestqi.com/wcq/wcq.html

On September 25th, John will teach at the Colorado School of Traditional Chinese Medicine in Denver. He will teach a 1/2 day on his Integrative Diabetes Protocol and a 1/2 day on the modern clinical applications of the Pi Wei Lun classic. If you are in the Denver area, we hope to see you there. http://www.cstcm.edu/pda/all

Please join us on Facebook “Alameda Acupuncture – Dr. John Nieters, L.Ac.” Upcoming events are listed and links to information about Chinese Medicine and podcast updates.

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New Living Expo Apr 29-May 1

The New Living Expo focuses on incredible opportunities available for healthy, spiritually fulfilling, environmentally sustainable, and socially just lives! At the San Francisco Expo, you will find information nuggets and fabulous services, all geared to help navigate your healing, growth, and green living adventure.

BROWSE this year’s bustling marketplace with 300 exhibits and TAKE YOUR PICK
from over a dozen of free workshops, 3 special events, 4 free panel discussions, 100 free lectures throughout the weekend, all connecting body, mind and spirit.

Knowledge is power! Mingle with like-minded people and experts that are connected with the evolving human empowerment and global community.

Exhibitors ~ Panel Discussions ~ Workshops ~ Lectures ~ Special Events ~ Expo Bookstore ~ Business Opportunities ~ Green Food Court ~
Anti-Aging ~ Bodyworkers ~ Green Business. For more information visit
www.newlivingexpo.com or call 415.382.8300
General Admission includes:
Workshops, Lectures, Panels & Exhibits
Order Tickets in Advance or info
(415) 382-8300
Volunteer:
(415) 751-6443

Ride BART to the Hotel Whitcomb, Civic Center, and ride our FREE shuttle to the Expo. Bring your BART receipt and receive $5. off admission

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World Congress on Qigong and TCM

The World Congress is an official fundraiser for Japan Disaster Fund. Attend the Congress and support the relief effort while joining like-minded people who rely on natural ways to promote health and longevity. Learn techniques to enhance your own health and survive environmental degradation and man-made disasters.  Please print out/post the attached flyers and distribute this message liberally with a personal appeal to your newsletter, email list, social and professional networks to join you at the Congress. Those who must miss out on this provocative event may still make a donation on the registration page at eastwestqi.com. Scroll down this page for fundraising details.

Chow Qigong Meditation for Japan: At 12 noon, the time of the heart in Traditional Chinese Medicine, breathe deeply and properly with the diaphragm, feel connected to the entire universe, image Japan, the people (and the planet) in total pristine beauty whatever you envision that to be.  Do not think of the ugliness and destruction at all; only keep beautiful images and thoughts for the land, humans and animals. It is equally important to end the meditation feeling yourself strong, powerful and serene.

*Entry includes full Congress, Tai Chi and Qigong Day Grand Opening, Saturday evening dinner Gala, Sunday Science Symposium and lunch and a full roster of world-class presenters including Celebrity Author/Naturopathic Doctor to the Stars Sharyn Wynters and Martial Artist/Film Star Cary Tagawa!

Visit eastwestqi.com to register and find full details of the program. Organizers need help now in producing this year’s  Congress, volunteers are needed now!

In health and happiness,
Ann Colichidas
Chow Qigong, San Francisco
415-902-7690

A letter from Dr. Effie Chow….

Please take this as a personal note to you.   We very much need your help in fundraising for the Japan disaster!

We have made our East West Academy of Healing Arts sponsored fabulous Thirteenth World Congress on Qigong/TCM into a fundraiser for the Japan Disaster Fund.  This earthquake, tsunami and nuclear catastrophe is not only destructive to Japan, but to us and to the planet!  There is no containment for chemicals/gasses/energy…

I envision that the desperate circumstances in Japan are a clarion call for us in the Qigong/TCM/Natural Healing/CAM community and friends as a supreme opportunity to unite together as a powerful force to be respected and honored and to make a significant impact world-wide.  We all have been working individually heroically and idealistically for health for the individual and the planet to try to prevent what has just happened!  But isolated and separate as “I” and “You”, is not enough…..it must be a concerted collective “WE”.  We individually have not been able to make the mainstream listen to our daily healing miracles (where all else had failed), and our scientists attempting research in this field is frustrated with “NO MONEY”, yet research results and data is requested otherwise our daily miracles are “only stories”.

NOW is the opportunity to become a strong influential force for pro-active action in the DEVELOPMENT of public policies in health and life at the Washington DC and international level to include Qigong/TCM/Natural Healing/CAM, not to only react/complain when it is already legislated…..At present our community have no voice nor official status to do this. This is why I feel that if we can speak strongly through our cooperative efforts and our ability to raise significant funds to aid in Japan’s crisis, they will begin to hear us!  Unfortunately it is money that speaks the loudest in this western society and today’s world.

Our goal is to raise at least $50,000 by the end of the Thirteenth World Congress, May 2, 2011 by each one of us soliciting our contacts to donate!  Can you please encourage your “loyal fans/students/clients/friends” to donate to the Japan Disaster Fund?  With your immense mailing list…with encouragement, you can make such a significant dent into that goal!  Large or small it will be very much appreciated and truly make a difference.  I am CONFIDENT that if we continue to combine our forces together, that in the next year before our next World Congress in 2012 we can raise at least one million dollars (hopefully many millions) for the Japan crisis (other crisis?), but also for Qigong/energy natural healing research and to influence policy development.

One of our goals of the Congress was to be a springboard for raising funds for Qigong/Energy Healing Research, but for this Congress, because of the Japan emergency status we will now designate our proceeds from the activities leading up to and the days of the Congress to the Japanese Relief Fund.   We are working with the Japanese Cultural and Community Center of Northern California in San Francisco which is one of the largest Japanese commmunities in the nation.  They have identified trusted NGO’s in Japan to work with, one being the YMCA.

For one who wish to donate, they can come to our Congress to show personal support, and/or if they cannot come, we appreciate a donation large or small.  It all will add up.  We will be setting up a family tree of contributors to the Qigong/TCM/Natural Healing/CAM community fund for Japan.  This will document our strong force of cooperation amongst this community.

We wish also to make this fundraising a serious one with fun kinds of activity!  Our Congress program will be a spectacular extravaganza as usual and even better this year with the stars involved! People will learn to heal self and others as they help in a global disaster! There will be a friendly competition with prizes for those who raise the most monies in these categories:
1)  Individuals
2)  Corporations and businesses
3)  Non-profits and community agencies
4)  Media TV/Radio programs
5)  Stars for Qigong/TCM/Natural Healing/CAM community

Suggestions:
1)  One can also donate books, videos, products, classes for our raffle/silent auction and the donor will receive further publicity for their work and products. One can designate a certain percentage of their earnings in the next few months to the Japan Fund
2)  Be an ambassador to motivate your circle of friends/acquaintances to help raise money.
3)  If you know restaurant or business owners, inspire them to dedicate certain days that they will give a certain percentage to the Japan Fund.  It will also be good for their business.
4)  People can pledge to be responsible for raising or donating a certain amount of $ by a certain time.
5) Put on small or large local fundraising gatherings, dinners, etc.
6)  And many more ways….we are open to suggestions.

To donate, one can do the following:
1)  Credit cards:  go to on-line registration form for the Congress: www.acteva.com/go/eastwestqi ;
2)  Checks:  Make out to Congress- Japan Fund and send to: Acteva Inc. – Thirteenth World Congress on Qigong/TCM, 100 Pine Street, 10th Floor, San Francisco, CA 94111.  Phone: 866-462-2838, Fax Donation/Registration: 415-276-2399.  Call Acteva Support: 877-855-8646.
3)  For information please call 415-285-9401.

I look forward to your comments and suggestions or other creative ideas, and your partnering with us.

Thank you and Blessings.

In loving Qi,
Dr. Chow

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March 2011 Acupuncture for Fibromyalgia

In This Issue (Get QiMail delivered to your inbox )
– Acupuncture and Oriental Medicine for Fibromyalgia Syndrome
– Alleviate Your Fibromyalgia Symptoms
– Fight Fibromyalgia with Nutrient Dense Foods
– Meditation: Mindful Being

Acupuncture and Oriental Medicine for Fibromyalgia Syndrome
Fibromyalgia Syndrome (FMS) affects an estimated 2 percent of the population. Research shows that up to 90 percent of people with fibromyalgia have turned to complementary and alternative medicine to manage their symptoms. Acupuncture, in particular, has become a popular treatment choice and has shown to be an effective treatment for fibromyalgia.

What is Fibromyalgia Syndrome?
Fibromyalgia is a medically unexplained syndrome characterized by chronic widespread pain, a heightened and painful response to pressure, insomnia, fatigue, and depression. While not all affected persons experience all associated symptoms, the following symptoms commonly occur together:

• chronic pain
• debilitating fatigue
• difficulty sleeping
• anxiety
• depression
• joint stiffness
• chronic headaches
• dryness in mouth, nose, and eyes
• hypersensitivity
• inability to concentrate (called “fibro fog”)
• incontinence
• irritable bowel syndrome
• numbness, tingling or poor circulation in the hands and feet
• painful menstrual cramps
• restless legs syndrome

Fibromyalgia is diagnosed when there is a history of widespread pain in all four quadrants of the body for a minimum duration of three months and pain when pressure is applied to at least 11 of 18 designated tender points on the body. On its own fibromyalgia does not result in any physical damage to the body or its tissues and there are no laboratory tests which can confirm this diagnosis. 

Symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event. Women are more prone to develop the disorder than are men, and the risk of fibromyalgia increases with age. 

An Oriental Medicine Perspective
The Oriental medicine theory of pain is expressed in this famous Chinese saying: “Bu tong ze tong, tong ze bu tong” which means “free flow: no pain, no free flow: pain.”

Pain is seen as a disruption of the flow of Qi within the body. The disruption of Qi that results in fibromyalgia is usually associated with disharmonies of the Liver, Spleen, Kidney and Heart Systems.

The Acupuncture Treatment
Oriental Medicine does not recognize fibromyalgia as one particular disease pattern. Instead, it aims to treat the specific symptoms that are unique to each individual relevant to their constitution, emotional state, intensity and location of their pain, digestive health, sleeping patterns and an array of other signs and symptoms. Therefore, if 10 people are treated with Oriental medicine for fibromyalgia, each of these 10 people will receive a unique, customized treatment with different acupuncture points, different herbs and different lifestyle and dietary recommendations.

Because symptoms of fibromyalgia vary greatly from one person to another, a wide array of traditional and alternative treatments have been shown to be the most effective way of treating this difficult syndrome. A treatment program may include a combination of psychological or behavioral therapies, medications, exercise, acupuncture, herbal medicine and bodywork.

If you have fibromyalgia, acupuncture and Oriental medicine may be what you’ve been looking for to ease your symptoms and reclaim your health and vitality. Please call for a consultation today.

Alleviate Your Fibromyalgia Symptoms
Although fibromyalgia is a disorder considered disabling by many due to chronic widespread pain and fatigue there are some things you can do to alleviate the symptoms and improve your overall quality of life.

Learn and Practice Stress Reduction Techniques
Chronic stress can lead to fatigue, depression, a weakened immune system, and a host of serious physical and psychological ailments. When under stress your muscles contract and tense affecting nerves, blood vessels, organs, skin and bones. Chronically tense muscles can result in a variety of musculoskeletal conditions and disorders including muscle spasms and pain. While it isn’t always possible to remove the external forces causing stress the ability to effectively deal with stress is a choice. Take time for yourself to cultivate the energy you need to handle your stress more skillfully and effectively. 

Eat a Well Balanced Diet
Managing your diet may seem time-consuming but the benefits it offers make it worthwhile. Many fibromyalgia sufferers find relief through a properly managed diet. A list of basic nutrients to combat nerve sensitivities, improve cognition, boost the immune system, and reduce swelling is included in this newsletter.

Exercise 
While even basic movements may be painful exercise helps restore strength and endurance. Tai Chi, Qi Gong or Yoga are great for easy stretches, careful strengthening, deep breathing, along with relaxation techniques. The gentle stretching will clear tension that builds when muscles tighten and tense and improve overall circulation. Be sure to check with your doctor before starting any exercise program. 

Meditate
The practice of meditation is a proven stress reducer that helps the body create a sense of calm and a continuing sense of well being. While 15 minutes is recommended, even 5 or 10 minutes can have a powerful effect on your day.

Restorative Sleep
Get at least 8 hours of restorative sleep. Maintain a routine sleep schedule and make your bedroom a sanctuary from every day stress. Practicing good sleep hygiene will give your body an opportunity to get stronger and heal.

Fight Fibromyalgia with Nutrient Dense Foods
The National Fibromyalgia Association recommends a balanced diet containing nutrient dense foods free of artificial additives and sweeteners to help your body fight fibromyalgia syndrome. Incorporate these nutrient rich foods in your next meal:

B-Complex
Found in whole grains, beans, nuts, chicken, fish and eggs; B complex vitamins directly influence the nervous system’s proper functioning and combat nerve problems such as tingling and tenderness.

Magnesium
Found in nuts, grains, beans, fish, meat and dark green vegetables magnesium is needed for muscle flexibility and bone, protein and fatty acid formation. Magnesium is also integral in making new cells, relaxing muscles, clotting blood and activating B vitamins.

Omega 3
Directly affecting cellular function this fatty acid found in fish minimizes nerve sensitivity and improves cognition.

Vitamin C
Helps combat stress, builds the immune system, and reduces swelling. Vitamin C is found in a variety of fresh fruits and vegetables including citrus fruits, green vegetables, tomatoes, and berries.

Water
Increases circulation of oxygen and nutrients throughout the body and helps to eliminate waste

Meditation: Mindful Being
The practice of meditation is a proven stress reducer that can help you tame your mind and overcome anxieties, agitation, and habitual thought patterns. 

To Meditate:
Create a quiet, relaxing environment sitting upright in a chair with your feet firmly planted on the ground, allowing for free and easy breathing. 

Relax your shoulders and gently place your hands on your knees or in your lap. Tuck your chin in slightly and keep your eyes half open, gaze softly focused downward about four to six feet in front, your mouth slightly open.

Observe your breath. Don’t accentuate or alter the way you breathe, just let your attention rest on the flow of your breath.

Allow the “chattering” in your mind to gradually fade away. If distracted by a thought, gently refocus on your breathing.

Focus on your breathing for 10 or 15 minutes. Stay relaxed, yet awake and attentive.

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