Author: Kacie Cotter-Harrigan

WHAT A YEAR! As the year comes to an end I have been reflecting on my own ups and downs and trying to find my bearings again. It has definitely been challenging at times. In the recent past I have been dealing with some injuries and noticing that my soon to be 50 year old body doesn’t recover quite the same way I am used to!

This past week I had a headache that simply wouldn’t go away, and if you were unfortunate enough to see me you may have encountered a very grumpy person. Now that it has gone away I can see how my mind would focus on “why” it started hurting instead of what made it feel better at this moment. 

I kept complaining about how “I couldn’t concentrate on anything” instead noticing that the pain was “telling” me that my headache was coming from my neck. So clearly what I needed to concentrate on was what the pain was showing me because that is exactly what I have spent the last almost 25 years teaching patients. 

When my wife helped me with neck mobilizations and manual therapy techniques I use in the clinic, I definitely felt better. But instead of following my own advice, I simply went back to my list of responsibilities I wanted to get done, despite the fact I couldn’t really concentrate and I didn’t really get anything done. I definitely found myself doing exactly what my patients do…ignoring their pain and worse yet avoiding the very thing that makes them feel better. Weird!

So today I thought I would share some of the recommendations I offer to my patients that have had the most beneficial results. And hopefully “I” will be smarter next time and follow these guidelines myself. 

First things first…it is important to understand that pain is not a problem as much as it is a clue. Your body is showing you that it is not happy about something…or that we need to pay attention to something. It is important to figure out what the pain is trying to show us and how to prioritize what to focus on so we can find a solution. 

Pain is often the body’s way of guiding us back to health and well-being. Let me share how pain can guide us. 

The location of pain and the duration of pain are often more important than the intensity of pain when determining the severity of the condition. And therefore more important for identifying the course of treatment. 

Let me give you a couple examples. 

• Take your left hand and grab your right index finger…bend it backwards slowly until you feel a strong stretch. Notice that as you apply more force the location of where you feel something grows. The more strain to the tissue the bigger the area of symptoms. This often happens as the condition worsens. A degenerated hip for example can start as a pinch in the groin and eventually encompass most of the thigh and pelvis. 
• Next, imagine taking a hammer and hitting your thigh muscles…the harder you hit the thigh the bigger the bruise. Similarly the bigger the area of pain the more likely the issue is more significant. Think of lower back pain as compared with sciatica. In both cases the source starts in the back but sciatic pain travels all the way to the toes. The further down the leg the pain goes the more serious the condition.

Typically the bigger the area of symptoms the more severe the condition. It can also inform us of the status of the condition, meaning is the condition getting better or getting worse. If the area is getting bigger the condition is getting worse. Whereas when the area gets smaller, the condition is likely improving. For example if you had sciatic pain that traveled to your toes but now it is in your lower back and buttocks…that means you are getting better. 

It is important to meet pain where it is at this moment. Two of the most common mistakes patients make is doing too much too soon or not doing not doing enough soon enough. Generally when things are improving we don’t want to interfere with the progress by adding to it just for the sake of adding. Whereas if the condition is getting worse we want to change the course somehow so it will start to improve. Having a physical therapist guide you will make all the difference.

The duration of pain is another clue that often matters more than the intensity of pain. For example, I rarely get worried about a patient that describes  their pain as 10 out of 10…but it only lasts for a split second or a few minutes. I am way more concerned when a patient has pain that goes from a 3/10 to a 5/10…but stays a 5 out of 10 for 3-5 days. The longer duration tells me this is significant. 

Meaning even though the intensity only changed from mild (3/10) to moderate(5/10)…the fact that it stayed increased for 3-5 days (i.e. longer duration) is more concerning for me. In this scenario, whatever is being done is making the condition worse. I would change the approach to stop the regression. Whereas a spike in pain (i.e. a brief 10/10) only tells me to be cautious but doesn’t provide enough information as to whether or not I should proceed or should change course.

The intensity of pain can be important of course, but it is also fairly easy to figure out by looking at someone instead of asking them to tell me how intense the pain is. Someone that comes into the clinic in severe pain often has a noticeable appearance. The look on their face, their demeanor, the sweat on their forehead from obvious distress, the controlled way they move, etc. 

 To help translate the clues, I recommend that you write a few things down. 

1. What is guaranteed to make you worse?
• Worse means that your symptoms increase and STAY increased for several hours or days.
• Worse also means that the location of symptoms is bigger or travels further away from the main source of pain.(i.e. Nerve pain travels from the back down the leg).

2. What is guaranteed to make you better?
• Better means that your symptoms decrease and STAY decreased.
• Better also means that the location of symptoms is smaller or gets closer to the site of injury/trauma. 

3. Stick with moment to moment assessment. 
• Forget yesterday and focus on just now..right now. 

If I had listened to my own advice, I would have remembered that when the patient (me) finds what makes them better, that doing more will help them (me) feel better. The most effective treatment is to do more of what helps and stop doing what makes it worse (as defined above). It sounds simple but it is absolutely the starting point and will often lead to better results…faster! Knowing that location of symptoms and duration of symptoms are a better guide will hopefully help you to focus on what is helping so you can improve your pain and get back to the life you want to live!

I would like to take the opportunity to say thank you to my staff for doing such great work throughout this difficult year, also to the patients we are privileged to treat for working hard and taking care of yourselves. Also I would like to thank the community for being so nice and supportive to me and my family!

We are here to help so please feel free to contact us at 518-306-6894 or on our website, www.goodemotept.com. We are seeing patients in the clinic and will continue to stay open for in person care. We are following all NYS and CDC guidelines for COVID-19 and offering virtual therapy for those that prefer to stay at home. 

Happy Holidays and Happy New Year!

I haven’t always been great about getting holiday decorations up in a timely manner. 

When my big boys were very little, it didn’t matter so much, since they didn’t know the difference, and as we had more babies, I had less and less mental energy to think about such things. But I always did get the decorations up eventually, even if it was with mere days (or even one day) to go until Christmas.

Our decorations are modest: we have a few Christmassy items that I put out around the house, and we decorate our Christmas tree with white lights and garland, topped with a star, and hung with ornaments. We have some store-bought ornaments and ones that were given to us, but my heart belongs to the ones the boys have made in school. Every year before Christmas, certain grades have ornament-making sessions, and I treasure what my boys have brought home: the wreaths made out of rice; the gingerbread men made out of glue and cinnamon that make the house smell like cinnamon until I pack them away after the Ephiphany; the Baby Jesus in the manger made out of construction paper and a clothespin. We have several of these same ornaments, since we’ve had several boys go through these grades, and I’m pretty sure my parents have some of the same ornaments on their tree from when my brothers and sisters and I were little.

Mom and Dad are in a new house for Christmas this year, after having sold our childhood home two years ago and been displaced last year while their new house was being fixed up, but so many of the same Christmas decorations they’ve always put out are currently on display. The stockings my grandmother knitted for each of us are hung, not on our old mantel in our old house, but in a new spot. Dad replaced some outside bulbs with red and green ones, as they’d done at their old house, and Mom’s love of stringing colored lights and putting candles in the windows has followed them to their new house, as has the Nativity scene she loves to put outside and the construction-paper Rudolph that one of my sisters made when she was little. We would get so excited when we saw the decorations get pulled out of storage each year—it felt like the Christmas season was really here.

Despite my humble attempts over the years, I see that my boys have that same feeling when I pull out our decorations, and with 2020 being the way it is, I really wanted to have my act together. I’m pleased to say that, as of this writing, I’ve strung lights and pine boughs above our main window; we have a Merry Christmas banner and a string of gold stars strung in various rooms; I put snowflake clings on our front door window and hung a big wreath on the door itself; and put the small statue of Santa on the piano (our Nativity set was never put away—it’s been hanging out by the video games since last year). And tonight, we’re putting up the tree and decorating it, nearly three full weeks before Christmas! 

When I told the boys that we would be putting up the tree tonight and that we would be having finger foods and watching a Christmas movie while doing so—a routine we started several years ago that we’ve actually been good about keeping up with—one of my big boys sighed and said, “I love that tradition.” We always joke that another of the boys is like Clark Griswold in National Lampoon’s Christmas Vacation—he really wants the totally tricked-out house and is always disappointed that we don’t cover the outside of our house in lights—but even he was excited when he came home from school the day I’d put up the decorations inside and said, “Oh Mama! The house looks so nice!” None of us complained when one of our favorite radio stations started playing Christmas carols on November 1, and I’ve caught more than one of the boys humming those familiar tunes as they go about their day (I sing them full out all the time, much to the bigger boys’ chagrin).

I love how somewhat unremarkable Christmas traditions can be and still be meaningful, and how easy it is to start new ones that children latch onto and love. The fostering of such excitement seems more important this year than ever—we all seem primed to embrace wholeheartedly anything that provides some light and joy and hope. I hope you’re all finding ways to let this “most wonderful time of the year” light up the end of your 2020, even amidst the darkness, and I hope the Christmas carol is right: “Next year all our troubles will be out of sight.”

Kate and her husband have seven sons ages 16, 14, 12, 10, 8, 6, and 2. Follow her at www.facebook.com/kmtowne23, or email her at kmtowne23@gmail.com.

This Holiday season has been challenging as family members chose whether or not to travel and spend time together after months of time apart.   

Many family and friends have different comfort levels of what works for them in terms of safe practices during a pandemic.  The key to navigating this time and making your self-care a priority is to be clear with yourself and others what your vision of a safe and peaceful holiday looks like and communicate that plan unapologetically and confidently.

This year after being apart from many family members for what will be a year next month, we made the decision to stay home for Thanksgiving and not travel.  While in my heart I wanted to spend time with family and friends I immediately felt anxious and uncomfortable at the thought of several families coming together under one roof to spend time together and share a meal.

What I have learned personally and professionally is that the path of peace is always the path that will be right for you.  Do not let yourself be guilted or manipulated into veering off the path of peace to accommodate someone else’s agenda.  Choosing to people please over peace of mind will always leave you feeling emotionally hungover in every way.

I often get asked by clients, “Isn’t that selfish to not see family and friends, don’t you think that is harsh?” Pandemic or not, self-care should be what you honor above all else.  What is selfish is someone giving you a hard time and using guilt as a way to get what they want.

Self-care sounds like this, “I’m really feeling overwhelmed and tired not to mention anxious about numbers rising again, what works for me this year is to limit contact outside to those I only live with and lay low.  While I would love to see everyone, I need to honor what I feel comfortable with.  I appreciate your understanding.”

Selfish sounds like this, “I can’t believe you won’t be coming over for Christmas, everyone is really upset and we all miss you so much, I just don’t see the harm in stopping by for dessert, what’s the big deal?

Self-care sounds like this, “I am disappointed too and for me this is what works this year.  When things settle down and are less risky, we can talk about getting together.”  End conversation and don’t take the bait of guilt.

A person who respects your boundaries would respond like this, “While we will miss seeing you this year, I understand how you feel and would not want you to feel anxious or uncomfortable about getting together.” No guilt, no manipulation, no drama and no emotional hangover.  Clean and direct.

2020 has brought us many lessons; perhaps the one we can practice this month is to continue to honor our boundaries and to communicate in a clean, direct way leaving no room to be bullied into serving someone else’s agenda.

These are lessons and styles of communication that we have to practice regularly in order to build up the muscle of confidence and ease in communicating our needs.  Once you practice this it gets easier and easier and the fear of conflict or a negative reaction begins to diminish.

I work with individuals who are working on this in their late teen years and others who are in their eighties. It’s never too late to learn how to honor what works for you.

YOU ARE WORTH IT!

Meghan Fritz is a psychotherapist practicing at Fritz, Stanger & Associates. Telehealth appointments are available, visit www.fritzstanger.com for more information. 

Imagine in February of 2020, if I had asked you about your ‘maskne.’ How would you have responded? 

However, in November 2020, the majority of people are familiar with this portmanteau of mask plus acne that has been added to our coronavirus lexicon to describe acne breakouts, dry skin and irritation caused by chronic mask use. The ubiquitous fashion accessory of 2020 has come with some unexpected side effects. In the dental office we are seeing an explosion of complications arising from mask usage and while the most common complaint is bad breath, the more serious concerns are increased dental decay, gum disease, temporomandibular joint (TMJ) dysfunction, facial pain and bruxism (tooth grinding).  

‘Mask Mouth’ is the new term being given to the associated dental diseases arising from chronic mask wearing.  The Center for Disease Control (CDC) acknowledges the efficacy of face masks in blocking the release of small respiratory droplets that may contain the COVID-19 virus and therefore the use of face coverings is essential to help curb the spread of this virus.  The three most common types of masks are cloth masks, surgical masks and respirators like the n95 or kn95’s, more commonly worn by healthcare providers.  While the importance of mask use is indisputable, acknowledging the side effects and planning accordingly will help limit potential damage.

HALITOSIS (BAD BREATH)
Bad breath has been the most common complaint from wearing a mask.  The bacteria in our mouth produce a sulfurous compound called methyl mercaptan.  This is often described as smelling like cabbage or rotting eggs and is believed to be responsible for halitosis.  When you are wearing a mask many people breathe through their mouth instead of through their nose.  This leads to a decrease in saliva and dry mouth (xerostomia).  Saliva is responsible for washing away the build-up of bacteria that forms a biofilm on the teeth.  Saliva also contains antimicrobial agents that help reduce the bacterial population and contains an abundance of minerals necessary for remineralizing enamel.  Dry mouth increases your bad breath by allowing far more bacteria to populate.  In addition to mouth breathing and dry mouth, people are drinking far less water because it is often cumbersome to remove the mask; this is especially true for those of us working in the healthcare field where donning and doffing (applying and removal) of personal protective equipment can be quite a chore.  This increased difficulty decreases water intake throughout the day leading to further dehydration.  Lastly, during the pandemic we have seen an increase in coffee and alcohol consumption, both of which worsen dehydration and lead to increased dry mouth. 

There are several steps you can take to help prevent dry mouth and improve your bad breath.  First drink more water throughout the day and try to decrease your coffee and alcohol intake.  Set a schedule for water consumption throughout the day if necessary.  Try a humidifier while sleeping to increase the ambient moisture.  Use an alcohol-free mouth rinse and a tongue scraper to help decrease the bacterial load and increase the frequency of your professional dental cleanings. Lastly, there are excellent over-the-counter oral health care products, such as Biotene, that have been specifically designed to help with xerostomia.

TOOTH DECAY AND GUM DISEASE
While bad breath may be the number one concern for the patients, tooth decay and gum disease are far more concerning to your dentist.  The decrease in salivary flow from dehydration and dry mouth allows for a build-up of bacteria, particularly around the gum line of your teeth.  Since the root surface of your tooth lacks the hard-protective enamel coating it is much more prone to decay and that decay spreads much faster.  Your saliva is a natural buffer, neutralizing acid from food and bacteria, as well as being supersaturated with minerals like calcium that help to mitigate the damage from the acidic challenge produced by these bacteria.  Dry mouth will also allow food particles normally swept away to stay stuck around and between the teeth serving as a food source to the adherent bacteria, increasing the likelihood of decay.

Additionally, without saliva to help lubricate and wash away the bacteria, it will begin to harden on the tooth surface converting from plaque to tartar or calculus.  This hardened build-up of bacteria on the tooth will cause irritation and inflammation of the tissue and underlying bone.  If this build-up is left untreated it can lead to an irreversible loss of the supporting structures known as periodontal disease or loss of the protective keratinized tissue around the tooth, known as gingival recession.  In addition, the inflammation caused by periodontal disease has been associated with multiple systemic conditions including heart disease and diabetes.  While gum disease is painless in the early stage, bleeding gums when you brush and floss is a good indication that the inflammation is progressing. 

Chronic mask usage may also be responsible for making the bacteria in your mouth more aggressive.  There has been some misinformation regarding the use of cloth or even surgical masks, implying their use can cause a decrease in blood oxygen (hypoxia) or a build-up of carbon dioxide in the blood (hypercapnia).  While this has been shown to be false, there remains some debate as to whether the extended use of masks, particularly a respirator-style like an n95, may result in a slight carbon dioxide increase over time.  Now while this build-up is thought to be so low that it doesn’t affect the general health of the wearer, any increase in carbon dioxide in the mouth would favor the proliferation of more virulent and aggressive anaerobic bacteria.  This could worsen the potential for decay and gum disease over an extended period of time. 

TMJ DYSFUNCTION, FACIAL PAIN AND HEADACHES
TMJ dysfunction, facial pain and headaches are an unexpected side effect of chronic mask use and have proven to be a real problem for many people.  Dentists have seen a significant increase in the number of patients presenting with joint and jaw pain, headaches and facial pain. 

The temporomandibular joint is a sliding hinge joint that connects the jawbone (mandible) to your skull.  It is positioned anteriorly or in front of your ears and you can feel the joint move as you open and close your jaw by lightly positioning your fingers just in front of the tragus of your ear.  Temporomandibular joint disorders (TMD) are characterized by pain in the jaw joint and in the muscles associated with jaw movement. 

Often times, TMD is believed to arise in patients who are prone to clenching, grinding and nocturnal bruxism.  These habits are often associated with anxiety, stress and emotional disturbances. The coronavirus pandemic has certainly made anxiety, stress and emotional disturbances a common problem for many, many Americans, leading to significant increases in TMD. These problems are being mistakenly identified as sinus issues, toothaches, neck pain, facial neuralgias and headaches leaving those suffering without any relief. 

Why are masks hurting our jaw joints and causing so many complications? Many people are uncomfortable wearing a mask.  Often, the wearer will tense the jaw and jaw muscles to help hold the mask in place. It results in increased small jaw movements as people attempt to move the mask away from their face and mouth, or attempt to reposition the mask to keep it in place or release the tension on the bridge of the nose or the face. It is this constant muscle tension and movement that fatigue and overwork the muscles of mastication leading to pain. 

Many people protrude the lower jaw in an effort to ‘tent’ the mask away from their face.  This is especially common in children or those suffering from conditions that make them especially sensitive to touch or texture, such as Autism. Others subconsciously protrude the lower jaw to open their airway and increase breathing efficacy. This is especially common with geriatric patients and those patients with breathing issues.  Protruding the lower jaw will help increase airflow while mouth breathing to help overcome the resistance to airflow caused by the mask.  This is especially true in the healthcare environment and those wearing respirators and high-level surgical masks.

An additional cause of headaches from masks can be from the ear loops, which apply pressure to the auriculotemporal nerve (a branch of the trigeminal nerve) which runs just in front and above the ear into the scalp.  Compression in this area from tight ear straps can cause facial pain and headaches.  Using ‘ear savers’ or mask extenders allow you to eliminate the pulling or compression caused by the ear loops on most masks.

If you believe you’re suffering from TMD, headaches or facial pain associated with mask usage there are several steps you can take to help. Try to keep your jaw relaxed while wearing the mask, your teeth should not be touching, lips slightly apart and tongue resting lightly on the floor of your mouth. Try not to clench your jaws or protrude/push your lower jaw forward while wearing your mask. My other recommendation is something I call ‘M & M’ therapy. Unfortunately, it doesn’t mean you get to indulge in delicious candy-coated chocolates.  It stands for, Moist heat, Massage, Motion, Motrin (or any anti-inflammatory, such as ibuprofen), Mush diet, Mouthguard and Muscle relaxer. You want to treat early TMD symptoms with simple physical therapy; moist heat, massage and motion to help relieve muscle tension, use an anti-inflammatory to reduce swelling and pain in the joint, limit hard and tough foods (especially gum chewing), use a night guard to reduce further pressure on the joint and a muscle relaxer to help spasm.  If you’re not getting relief, you may need to consult your dentist.

ANXIETY, DEPRESSION, ISOLATION AND FACIAL PAIN
This time has been one of the most unique, scary, isolating, and depressing times anyone can remember.  It has tested the emotional constitution of many people and many of us have been forced to find different methods to cope with the isolation and stress.  Physicians and pharmacies are reporting significant increases in the number of prescriptions written and dispensed for antidepressant and anxiety medications during 2020. 

Many of the medications prescribed for the treatment of depression, anxiety and emotional distress are in a class of medications known as SSRI’s or selective serotonin reuptake inhibitors. SSRI’s block the reabsorption (reuptake) of serotonin into the neurons in the brain. Serotonin is a key hormone that stabilizes our mood, and promotes a feeling of well-being and happiness. Serotonin generally makes humans happier and less stressed.  Unfortunately, SSRI’s have a common side effect, they increase clenching and grinding. 

Reports have chronicled patients suffering with symptoms of bruxism, including jaw clenching, headaches, tooth grinding, and broken teeth after they began treatment for relief of depression and anxiety with common SSRI’s.  These medications include, Fluoxetine (Prozac), Seratraline (Zoloft), Venlafaxine (Effexor), Escitalopram (Lexapro), Paroxetine (Paxil) and many others.   

It seems counter intuitive that medications designed to make you feel better, less depressed and less stressed will paradoxically increase your clenching, grinding and nocturnal bruxism, leading to facial pain and even broken teeth.  It’s important as dentists that we recognize this problem and identify our patients that might be suffering so that we may take steps to mitigate this side effect and help our patients to a better quality of life. 

This year has been proven to be difficult in so many different and unexpected ways.  It is important that we take the necessary steps to protect ourselves and each other so that we may all get through this together.  It is also necessary that we, as medical and dental professionals, recognize the new challenges that face us during this time.  Mask wearing is important but it comes with consequences.  It is important to talk with your physician or dentist if you believe you are experiencing any of these symptoms.Stronger together. 

The end of another year is rapidly approaching, and just as you cross items off your checklist and prepare your home for the winter, it’s also important to complete maintenance items to prepare your finances to close-out 2020.

The first piece of financial housekeeping will be to begin to gather documents you’ll be needing just after the new year to prepare your taxes. Compile receipts for medical bills, tuition payments, child care and charitable contributions, among others.

While many of us will no longer be able to itemize deductions due to recent tax law changes, there are credits for things like child care and education expenses which you may still be eligible for. For those with large medical bills, mortgage interest, or who have been particularly philanthropic this year, you may still be able to itemize, so it is important to have those receipts handy.

When it comes to planning for your retirement, this is the perfect time to evaluate your contribution levels to your retirement plans at work. If you have the ability, and you’re not yet contributing to the maximum levels allowed, consider topping these accounts off to take advantage of the possible tax deduction this year, as well as the ability to simply squirrel as much away for the future as possible. Even if you can’t contribute to the maximum, be sure to at least contribute enough to take advantage of any employer matching contributions. 

You may not be aware, but once you reach age 50, you are eligible for higher contribution levels than in prior years. So, if you’ve turned 50 this year, consider increasing your contributions. For 401(k) and 403(b) plans, you can contribute an additional $6,000 to a max of $25,500 from $19,500 for those under 50. For SIMPLE plans, you get to contribute an additional $3,000, up to a new max of $16,500. Take advantage of this opportunity to catch-up on contributions you may not have been able to make when you were younger. 

On the subject of milestone birthdays, if you turned 72 in 2020, you would normally have to start having to take withdrawals from IRAs and certain company sponsored retirement plans. These are called Required Minimum Distributions (RMDs). Your contributions to these accounts have been allowed to grow tax-deferred all this time, and now Uncle Sam wants his share. This age limit was increased from 70 ½ by the SECURE Act in late 2019. However, due to COVID and the resulting CARES Act, you won’t need to take an RMD for 2020. RMDs from inherited IRAs have also been suspended for this year, but you should expect both to resume in 2021.

Even if you can’t itemize charitable contributions on your taxes, you may still be able to make those contributions on a pre-tax basis! If you direct distributions to be paid directly from your IRA to your charity of choice, you won’t be taxed on that portion of the distribution. This is a great option if you are subject to the standard deduction.

The end of the year is a perfect time to review your various forms of insurance, including your home and auto. Take note of various coverage limits and deductibles. If you can, consider a higher deductible in order to save on premium expenses. 

Ensure that your homeowners coverage amounts reflect the value of your home. Your home has probably appreciated since you purchased it, but have you increased your coverage limits to keep pace? 

An often-overlooked task is to review your beneficiary declarations each year. Families grow, as new members are added, and shrink with death and divorce, which means that beneficiary and Transfer-on-Death declarations can easily become outdated and no longer reflect your true wishes. 

Since these declarations are a matter of contract, they will overrule what your Will may say. So, even if you’ve updated your will to exclude an ex-spouse, but you left them as beneficiary on your IRA, your new spouse won’t be able to inherit those assets, but the ex will, and it can’t be challenged in probate.

Your Certified Financial Planner® professional is perfectly suited to help you mark most of these items off your list. Review your beneficiaries, gather tax documents, maximize funding of your various retirement plans, take required distributions, and review your insurance coverage with your advisor each year, to help ensure that your financial plan is well-tuned as you prepare to turn the page on 2020.

Stephen Kyne CFP® is a Partner at Sterling Manor Financial, LLC in Saratoga Springs and Rhinebeck, NY.Securities offered through Cadaret, Grant & Co., Inc. Member FINRA/SIPC. Advisory services offered through Sterling Manor Financial, LLC, or Cadaret Grant & Co., Inc., SEC registered investment advisors. Sterling Manor Financial and Cadaret, Grant are separate entities.