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Peaceful Balance Health & Wellness Services

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Peaceful Balance Health & Wellness Services

Dr. Lorraine Bock is a board certified nurse practitioner with experience in family practice and emergency medicine.

She has been providing primary care in Carlisle for over 25 years. Dr. Bock, CRNP is a skilled clinician and a tireless patient advocate.

11/20/2025

While November is a huge observer for Diabetes and Diabetic Eye Disease, there is another topic that deserves observance for the tiniest of humans, so this week we are highlighting Prematurity Awareness.

Premature birth occurs more often to African American and Indian/Native Alaskan mothers more than white mothers. It also is more common in mothers under 18 and over 35. Lifestyle choices such as smoking, illegal drug use, drinking alcohol, late or no prenatal care, domestic violence, long hours of standing while working, stress, exposure to environmental pollutants, and stress can also increase your risk of preterm labor or birth.

Risk factors for preterm labor are unfortunately endless, because we have not found them all yet. However health care providers may consider women high-risk for preterm labor or birth for reasons such as women who have already delivered a preterm baby, being pregnant with more than 1 baby, using assisted reproductive technology, and/or women who have reproductive anomalies (shortened cervix).

Certain medical conditions can also increase the risk for preterm labor and birth, some that only occur is pregnancy, such as: STIs, high blood pressure, UTIs, va**nal infections, va**nal bleeding, IVF pregnancies, fetal developmental anomalies, under/over weight prior to pregnancy, less than 6 months between delivery and another pregnancy, diabetes, gestational diabetes, blood clotting problems, risk of uterine rupture, and placenta previa.

What causes preterm labor and birth is only partly understood, very complex, occurs for numerous reasons. There are 3 main situations where preterm labor and birth may occur:
1. A non-medically indicated preterm delivery can result from inducing labor or having a cesarean delivery by choice, however it is not recommended. Research shows babies born at 37-38 weeks are at a higher risk for poor health outcomes than those born 39+ weeks.
2. Medically indicated preterm birth may occur if there is a serious health condition, such as preeclampsia. There are often other steps taken to avoid preterm delivery, however if it is needed, steroids may be given to improve outcomes for the babies health.
3. Spontaneous preterm labor and birth is unplanned, unintentional delivery prior to 37 weeks. The cause is usually unknown.

https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/treatments
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/who_risk
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/causes

11/19/2025

While November is a huge observer for Diabetes and Diabetic Eye Disease, there is another topic that deserves observance for the tiniest of humans, so this week we are highlighting Prematurity Awareness.
Premature birth is defined as babies who are born alive before prior to 37 weeks during pregnancy. Premature birth is the leading cause of infant disability and death worldwide; its estimated to be responsible for 900,000 deaths in 2019. Prematurity is also the leading cause of death of kids under 5. It was estimated in 2020 that 13.4 million babies were born before 37 weeks; that is 1 in 10 births.

Preterm labor and birth have no definite way to predict them, however there are certain instances when it is known that preterm labor is highly likely. A Shortened Cervix happens naturally as you progress into late pregnancy, however in some women it happens prematurely (around month 4-5) and increases the risk. It may be recommended to measure the cervix (especially if there is prior preterm labor or birth) using ultrasound. An Incompetent Cervix occurs when the cervix opens early, before a baby is ready to be born, where as typically in pregnancy it stays closed. Cervical opening is often painless and unnoticeable with no labor cramps or contractions.

There are limited options for treatment of preventing preterm labor and birth, often due to the fact that the cause is unknown.
- Cerclage is a surgical procedure done by placing a stitch around the cervix to keep it closed to increase the likelihood of full term birth. It may be used for women with an incompetent cervix or those who have experienced early pregnancy loss due to painless cervical opening.
- Hormone Therapy uses progesterone is though to prevent preterm labor and birth. "NICHD’s Maternal-Fetal Medicine Units Network found that progesterone given to women at risk of preterm birth due to a prior preterm birth reduces chances of a subsequent preterm birth by one-third, when started at 16 weeks of gestation and continued to 37 weeks of gestation."
- Bed rest; however it cannot prevent it for sure and it can have the opposite affect for some.
Risks and benefits should be discussed with healthcare providers for all treatment options to find the right fit for the mother-to-be.

https://www.who.int/news-room/fact-sheets/detail/preterm-birth
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/predict
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/treatments

11/18/2025

While November is a huge observer for Diabetes and Diabetic Eye Disease, there is another topic that deserves observance for the tiniest of humans, so this week we are highlighting Prematurity Awareness.
Premature birth is defined as babies who are born alive before prior to 37 weeks during pregnancy. Premature birth is the leading cause of infant disability and death worldwide; its estimated to be responsible for 900,000 deaths in 2019. Prematurity is also the leading cause of death of kids under 5. It was estimated in 2020 that 13.4 million babies were born before 37 weeks; that is 1 in 10 births.

Preterm labor has 3 sub-categories based on gestational age:
- moderate to late preterm is anywhere 32-37 weeks
- very preterm is between 28 and 32 weeks
- extremely preterm is anything less than 28 weeks

Signs and symptoms you may experience if you are in preterm labor (labor occurring between 20-36 weeks) can include:
- abdominal cramps or diarrhea
- low, dull back pain
- a feeling of pressure in the pelvis area
- leaking fluid or blood from the va**na
- contractions or tightening every 10 minutes or more
- cramps similar to menstrual cramps
Uterine contractions are normal during pregnancy but should not occur frequently, like 6 or more times per hour.

Preterm labor can be diagnosed by doing an evaluation. The evaluation may include a pelvic exam to check for rupture of the membranes, if the cervix is opening, and/or if the cervix is thinning. An ultrasound and electronic monitoring of any contractions and fetal heart rate may also be done. A test known as a Fetal Fibronectin (fFN) test can be sued to detect if fetal fibronectin protein (the biological glue between the membrane around the fetus and the uterine lining) is present. Typically this protein is only present at the beginning (up to 22 weeks) and at the end (37-40 weeks) but not during 24-34 weeks, therefore if it is present it can indicate preterm labor. If it is negative it is unlikely the woman will deliver within the next 7 days.

https://www.who.int/news-room/fact-sheets/detail/preterm-birth
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/symptoms
https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/diagnosed

11/14/2025

Last week we brought awareness to Diabetes, so this week on a related note we are bringing awareness to Diabetic Eye Disease.
Prevention breaks down to managing diabetes effectively, not smoking, limiting alcohol intake, maintaining a healthy weight, and having regular eye exams.

Diagnosis is typically made by an eye exam. To look closely at the retina a OCT, optical coherence tomography. A Fluorescein angiography (done with yellow dye, fluorescein) or OCT angiography (a newer technique that does not require dyes) may also be done to help view what is happening with the blood vessels in the retina.

A big part of managing and treating diabetic eye disease is monitoring blood sugar levels, managing diet, getting exercise, properly taking medication that's prescribed, regular physical exams, and regular eye exams. Eye treatments that focus on managing vision, managing eye symptoms, and limiting or slowing retinal damage. Treatments for diabetes-related retinopathy may include medications, laser surgery, and other eye surgeries.

You should call or see your provider if you notice any gradual vision changes like:
-vision loss or trouble seeing as well as you used to
-blurred or distorted vision
-areas in your vision that look dim, faded or different from how you saw before

https://www.aao.org/eye-health/diseases/diabetic-eye-disease
https://ophthalmology.wustl.edu/diabetic-eye-disease-awareness-month-what-is-diabetic-eye-disease/
https://my.clevelandclinic.org/health/diseases/8591-diabetic-retinopathy -and-tests

11/13/2025

Happy National Nurse Practitioner Week to our favorite Nurse Practitioner Dr. Lorraine Bock!!👩‍⚕️💉

11/12/2025

Last week we brought awareness to Diabetes, so this week on a related note we are bringing awareness to Diabetic Eye Disease.
Diabetic Eye Disease affects millions. It is predicted that the number of those with Diabetic Retinopathy will double between 2010 and 2050 (7.7m to 14.6m).

Symptoms of Diabetic Eye Disease may include:
-distorted or blurred vision, especially in the central field of vison
- spots, small speckles, of floaters in your vison field
- loss of color vison, colors less distinct or vibrant
- trouble seeing at night or in low-light conditions
- in advanced stages, loss of sight can occur and may not be reversible

While the main cause of Diabetic Eye Disease is consistently high blood glucose (sugar) levels, there are additional risk factors that increase the chances of development even more.
-poorly controlled blood sugar, with fluctuations
- pregnancy can develop or worsen Diabetic Eye Disease
- high blood pressure can exacerbate the effects of diabetes on the eyes
- high cholesterol can contribute to progression of the condition
- the amount of time the person has had diabetes

Diabetic Retinopathy often does not have symptoms till it is in a more advanced stage. Regular eye exams are crucial for this purpose.

https://www.aao.org/eye-health/diseases/diabetic-eye-disease
https://ophthalmology.wustl.edu/diabetic-eye-disease-awareness-month-what-is-diabetic-eye-disease/

11/10/2025

Last week we brought awareness to Diabetes, so this week on a related note we are bringing awareness to Diabetic Eye Disease.

Diabetic Eye Disease is the term to describe several eye problems that may result from diabetes. Even well controlled diabetes can affect regular eye care. Diabetic Eye Disease includes diabetic macular edema, cataract, glaucoma, and diabetic retinopathy.
-Diabetic macular edema occurs when fluid builds up on the retina and causes blurry vision and swelling. it can lead to permanent vision loss.
- Cataracts can be caused by excess blood sugar and may require surgery to remove the clouded lenses, which are a result of diabetes.
-Glaucoma is a group of diseases that cause damage to the optic nerve, which can result in irreversible vision loss. It is 2x as likely in those with diabetes.
-Diabetic retinopathy occurs when the blood vessels in the retina swell, leak, of completely close off. New, abnormal, blood vessels can grow on the retinas surface. The risk increases the longer the person has diabetes.

https://www.aao.org/eye-health/diseases/diabetic-eye-disease

11/07/2025

November is a new month and a new month brings new awareness to bring. First up in November is Diabetes Awareness Month. There are several different types of diabetes including type 1, type 2, gestational diabetes, and even prediabetes. In the previous posts this week we talked about the different types of diabetes and symptoms and treatment for each type. Today we will be discussing diabetes complications and common diabetes terms and devices.

Diabetes increases the risk of many other health problems that are very serious, however correct treatment and certain lifestyle changes can delay or even prevent the onset of complications. Other serious health complications may include:
- Neuropathy (nerve damage)
- Diabetes-Related Eye Disease (which is next weeks topic)
- Foot Complications; nerve damage, reduced circulation, or even amputation
- Chronic Kidney Disease
- Cardiovascular Disease (the leading cause of death in those with diabetes)
- Oral Complications; gingivitis (early gum disease) and periodontitis (advanced gum disease)
- Hearing Loss (twice as common in those with diabetes)
- Skin Complications
- Diabetic Ketoacidosis
- Stroke (chances are twice as high)

There are a lot of common jargon and abbreviations when dealing with diabetes.
A1C- a test measuring a person's average blood glucose level over 2-3 months
Hemoglobin- the part of the red blood cell that carries oxygen to cells and sometimes joins glucose in the bloodstream
Hemoglobin A1C or glycosylated hemoglobin- a test that shows the amount of glucose that sticks to the red blood cell
Blood glucose monitoring- checking blood glucose levels regularly
Blood glucose (blood sugar) level- amount of blood glucose at a certain time
Diabetic ketoacidosis (DKA)- an emergent condition due to raised blood glucose levels and a lack of insulin resulting in the breakdown of body fat and a build-up of ketones
Hyperglycemia- high blood glucose
Hypoglycemia- low blood sugar........and many more with the link attached below !

Diabetes devices have drastically changed from what they used to be. Now there are several different options to fit each persons needs.
-Blood Glucose Meters measure you blood glucose level with the prick of a finger and a few drops of blood.
-Continuous Glucose Monitors (CGMS) check your levels regularly and is worn all the time through a senor on the arm. CGMs will alert you when you blood sugar is too low or too high and can provide insight on glucose trends. It eliminated finger pricks and those both type 1 or type 2 can benefit from it.
-CMG Insulin Pumps takes the glucose data from the sensor and can either suggest changes to insulin doses or adjusts to the appropriate amount of background/basal insulin by its self (this is triggered when running high or low). However you will still need to take insulin at meal time.
-Syringes use a needle to draw out the necessary amount of insulin, therefor it is flexible in dosing. It is also cost effective as it is cheaper than pre-filled pens. Better for those requiring larger doses of insulin.
-Insulin Pens combine medication and syringe in one unit and are more convenient for on the go. The come preloaded with insulin and are fairly easy to use. Many brands often color-code the pens to make it easier to quickly identify the type of insulin.

https://diabetes.org/about-diabetes/complication
https://diabetes.org/about-diabetes/common-terms
https://diabetes.org/about-diabetes/devices-technology

11/05/2025

11/03/2025

November is a new month and a new month brings new awareness to bring. First up in November is Diabetes Awareness Month. There are several different types of diabetes including type 1, type 2, gestational diabetes, and even prediabetes.

Type 1 Diabetes:
Is an autoimmune disease in which your immune system treats beta cells in the pancreas, which produce insulin (a hormone that helps blood glucose or blood sugar enter the body to eventually be used as energy), as an invader and destroys them by mistake. When enough of those beta cells are destroyed, the pancreas cannot produce insulin or makes too little to live. When glucose cannot enter the cells it builds in the blood stream causing high blood glucose (hyperglycemia). High blood glucose causes harm to the body overtime and can lead to other complications. Typically it is diagnosed in young people, however it can develop at any age. Researchers have no idea what triggers or can prevent type 1 diabetes.

Type 2 Diabetes:
The body does not properly use insulin, insulin resistance. It starts with beta cells making extra insulin to compensate, however overtime the pancreas cannot make enough insulin to keep a normal blood glucose level. It most often develops in middle-aged and older adults, however is rising in young people.

Gestational Diabetes:
Also known as GDM, occurs during pregnancy and affects up to 9% of pregnancies each year in the U.S. It does not mean you had diabetes before or will have it after pregnancy. The cause of DM is not clear however the hormones from a placenta, which supports baby's growth, sometimes can block the mother's insulin and cause insulin resistance making it harder to use insulin in the body and require more from the mother. When the body cannot produce enough insulin during pregnancy during pregnancy, glucose remains in the blood which leads to high blood sugar.

Prediabetes:
Before type 2 diabetes most people have prediabetes, where the blood sugar is above normal but not high enough to be considered diabetes. Prediabetes does not mean you will develop type 2.

https://diabetes.org/about-diabetes/type-1
https://diabetes.org/about-diabetes/type-2
https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes
https://diabetes.org/about-diabetes/prediabetes

10/31/2025

Continuing to fishing October with Spina Bifida Awareness Month, our hope is to educate and bring awareness to this condition.

There is no certain way of preventing Spina Bifida or other neural tube defects, however you can greatly reduce your risk. It is advised to start taking folic acid supplements at least 1 month before becoming pregnant and continue through the first trimester of pregnancy.

Folic acid is essential in the early weeks of pregnancy to prevent neural tube defects. It is recommended people of child bearing age should take-in 400 mcg of folic acid a day. Foods high in folate or fortified folic acid are enriched bread, rice, some breakfast cereals, or pasta.

Adults planning to conceive should increase their daily intake of folic acid to up to 800mcg. Folate is not absorbed as easily as folic acid, therefor most people do not get enough folate from their diet alone. Folic acid vitamins are vital to lower the risk of Spina Bifida as well other conditions such as certain heart conditions, cleft lip, and cleft palate. Foods rich in folate or fortified with folic acid is present naturally in cow's milk, dark green veggies (broccoli & spinach), beans, peas, egg yolks, avocados, and citrus fruits & juices.

https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860

10/29/2025

Continuing to fishing October with Spina Bifida Awareness Month, our hope is to educate and bring awareness to this condition.

There is no known cause of Spina Bifida, however many think a combination of environment, nutrition, and genetic risk factors play a role in the cause. It is more common among Hispanic and white people, than other races. Female babies are also affected more than male babies.

Increased risk factors for Spina Bifida may include:
- A family history of neural tube defects; having one child with a neural tube defect slightly increases the risk of having another child with the same condition, and the risk increases every pregnancy. Also being born with a neural tube defect will increase the risk of giving birth to a child with a neural tube condition, however most are born to parents with no family history.
- Too little folate, Vitamin B9, can create a folate deficiency which increases the risk of Spina Bifida and other neural tube conditions. Folate is important to the babies development to be healthy; folic acid is the synthetic form often found in foods and supplements such as prenatal vitamins.
- Diabetes that is not well controlled before becoming pregnant
- Certain medications, such as anti-seizure medications, during pregnancy
- Obesity at the time of pregnancy
- Increased internal temperatures in early weeks of pregnancy, possibly from a fever, hot tub, or sauna

https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860

Address

9 East High Street/Rear
Carlisle, PA
17013

Opening Hours

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

Telephone

+17174400098

Website

https://peacefulbalancehealthcare.com/

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Heathcare Without the Hassle

In 1999 I opened Bock CRNP Services, PC with the goal to serve patients by providing accessible, high-quality primary care via a new model of care, the nursing model. Nurse Practitioners provide wholistic care that addresses not only the medical problems we have but also cares for family, your finances, your emotional health, and how your health impacts your life. I kept the practice open until 2014 by having partners, offering innovative services, and by working other jobs outside the practice. During that time I hassled with every insurance company. Either they didn’t recognize nurse practitioners as legitimate healthcare providers, they didn’t pay nurse practitioners directly, they limited the types of care I could bill them for, and/or they paid me 85% of what they would pay a physician to deliver the same service. I was able to make this work for 14 years but by 2014 I was losing money, patients, and working more and more at the office to keep the business going. I cried for 3 months as my loyal patients had their last visits with me and I moved on to working several other jobs including the emergency department, teaching, and in someone else’s practice.

All this was paying the bills and I had lots of free time. But....I was missing my patients and they seemed to be missing me. Every time I saw a former patient, on my page, and when they talked to other former patients, the message was the same, “When are you going to open another practice? No one takes care of me like you did.” Well I learned about Direct Primary Care and began thinking about opening a new practice. One that gave me financial security, with the freedom to spend as much time as I would like to with the patients in my care. I found a mentor and I learned as much as I can about Direct Primary Care, and guess what - it is what I needed to allow me to practice again in my own office.

So on November 12, 2018 I opened Peaceful Balance Health & Wellness Services at 9 East High Street - Rear. The space is intimate and personal - just like the care we provide. The name chosen in honor of my friend Joe Glogowski, who believed in me always. A Direct Primary Care practice in Carlisle, PA. I have my former staff assistant - Pattie Richwine working with me again and we are looking forward to growing and expanding our practice to care for everyone who needs access to healthcare. Please come talk to us about your health and the direct primary care model. You can finally get the healthcare you deserve.