Saturday, June 30, 2012

I’m Really Sick, But Don’t Tell Anyone

For the last five months I’ve been dealing with different types of situations , which are all rooted in what to do if family or close friends aren’t discussing their very significant and potentially life threatening health conditions. Note that this post is not about providers, which was covered in the May post Confidentiality, HIPAA and Getting What You Want.

Have you ever had a friend or family member tell you that they have a very serious health issue, and then add, “but don’t tell anyone?” If so, it may have been incredibly hard to keep that confidence and there might be a time you might find that you can’t.

The most recent situation that prompted this post is one where the person who is very ill, has relayed that they have some health issues, but not provided specifics to family and friends. Other than a spouse and a sibling, no one is aware that this is a life threatening illness the person is dealing with. On the one hand, they are rather blasé about it, but on the other, they are upset that no one is calling or stopping by.

There are lots of reasons people don’t want their health situation discussed, including
• Fear of what people will say and/or how they will react.
• Many don’t want to have to deal with other peoples’ emotional reactions to their situation, and/or their “helpful” suggestions.
• Fear of being discriminated against or being stigmatized, thereby loosing a job, promotion, housing and/or impacting relationships with friends, family and community.
• Not ready to accept the situation themselves, so don’t want reminders by having people ask them about it
• Don’t want to be a burden or have a fuss made over them
• It’s a way to exert control in a situation where the person feels powerless

There is limited research on those that don’t disclose their illness, but indications are that keeping this to your self isn’t such a great idea. Diabetes patients who have a lower propensity to reach out to others have a higher mortality rate than those who feel comfortable seeking support. These are the findings of a five-year study reported by Dr. Paul Ciechanowski, associate professor of psychiatry and behavioral sciences at the University of Washington (UW) and an affiliate investigator at Group Health Research Institute in Seattle.

In conversing with a friend, who is a minister, they noted the following, in the field of spiritual direction, keeping secrets and not being forthcoming is one sign of unhealth and is very damaging to the journey of the spirit. Interestingly, new research finds that the person having to keep the secret can also be negatively impacted.

In the April Journal of Experimental Psychology, Four studies examined the behavior of people who harbored important secrets, such as secrets concerning infidelity and sexual orientation. People who recalled, were preoccupied with, or suppressed an important secret estimated hills to be steeper, perceived distances to be farther, indicated that physical tasks would require more effort, and were less likely to help others with physical tasks. The more burdensome the secret and the more thought devoted to it, the more perception and action were influenced in a manner similar to carrying physical weight. Thus, as with physical burdens, secrets weigh people down. (PsycINFO Database Record (c) 2012 Scientific American has a very interesting pod cast on this research.

Over the years of working in health care, I have watched how confidentiality has become a very nasty weapon, particularly in the field of HIV/AIDS. It’s been used as an excuse to fire very compassionate and well trained health professionals, as well as pit caring family and friends against one another. More than once, I’ve been in situations where a person has relayed very personal health information with the “don’t tell anyone” caveat only to find months down the road, they had been giving the same information to others in their social orbit. Sadly, in some of these situations, if conversations had taken place among friends, life could have been a lot easier for the person who was ill.

As much as I think people do have real and realistic fears about disclosure, I’ve come to think of it equally as a way to try and have some control over a situation that is beyond one’s ability to manage it. In the early years of the AIDS epidemic, I saw that those infected with the virus who disclosed ultimately did better than those who didn’t. Yes discrimination happened, and it still does, but at the end of the day, it seemed to me that naming it and not keeping it a secret was more empowering. That said, each case is unique and needs to be dealt with accordingly.

Below are things to consider when someone tells you they are very sick but don’t want anyone else to know.

• The fact that they told you means they do want at least one person to know about it. Since a lot of reasons for not disclosing are fear based as well as a need for control, ask questions about why they feel the need for secrecy. Are there ways you can help them with disclosing or better manage their situation? A lot of times they do want others to know but they don’t know how to go about it. Of course, it’s also possible that they do just want one person to know, for whatever reason, but they don’t want it discussed and not even that much with you. If that’s the case, accept it and let it go.

• If they do want help in disclosing, suggest that they check with their conditions specific organization (e.g. American Cancer Society); social worker or case manager where they received their care; or their health provider. Since this is a common problem, there are often handouts and helpful tips which can make the process easier.

• If the person starts off by saying “I have something to tell you, but I don’t want anyone else to know,” definitely ask some questions about the possible content of the secret because if you aren’t sure you can keep the secret, let them know that right up front. It’s okay to say that if the secret involves something that could be harmful to them or someone else, you may not be able to honor the promise.

• If the person just blurts out their problem, following by the, “don’t tell anyone,” be clear with them if you don’t think you can keep the confidence. Remember you aren’t their therapist.

• There are times when you may need to tell someone of the situation. If the person is in danger, such as making suicidal or even homicidal comments; being abused or abusing someone else or jeopardizing the safety of self and others, then relaying information to someone who can help them is appropriate.

• Related posts: How to Respond when you learn that someone is ill or injured.

Wednesday, June 27, 2012

Tale a Break: Music Pass it On

This post is dedicated and inspired by Michael, who this past weekend, returned a book he had borrowed with a wonderful CD of Mercedes Sosa. I promptly downloaded the CD to iTunes and started listening.

I fell in love with this Argentine singer, whose story is as marvelous as her voice. I couldn’t help but think how wonderful the gift of music is. When my oldest son, who is a musician, comes home from college, he will turn us on to one of his new inspirations. It’s such a treat.

This week’s take a break is all about passing on music. You can do this by:
• Making a CD of favorite tunes for someone.
• Buy a CD and give it to someone that might love it
• E-mail friends with a video of one of your favorite musicians
• Purchasing concert tickets for someone
• Invite someone over to hear a favorite artist. Enhance the experience with something special to eat or drink.
• Show someone how to use Pandora

Share a favorite music video by posting it to the Healing Whole Facebook page.

Below are some links to music that friends and family have shared with me and so I pass them along with a note of thanks:
Mercedes Sosa (Thanks Michael)

Kenny Baker and Bill Monroe-Jerusalem Ridge: (Thanks Mark) Brought back many a fond memory of being at festivals and dancing to their music.

Rodrigo y Gabriela-Diablo Rojo Thanks Spenser

Desmond Dekker-Israelites (Thanks Spenser)

Tony Bennett & Amy Winehouse-Body and Soul Thank you Tony

Red Clay Ramblers-I Crept Into the Crypt Have to thank the old time community for this one, as I just can’t remember who took me to the concert at the Birchmere.

Saturday, June 23, 2012

mHealth: So What Role Does it Have in Your Care?

This past week I’ve come across some interesting articles that relate to chronic conditions and mHealth or mobile health- the term is used when discussing mobile devices that can help in the delivery of health care. For starters, how many people actually have a chronic condition? In the United States, one author states that 3 out of 4 people 65 and older have two or more chronic conditions.(JAMA ). The President of NEHI (New England Health Institute, Wendy Everett, was quoted as saying recently “Nearly half of all American adults have at least one chronic illness.” In short, there are lots and lots of people with at least one chronic condition, and with the baby boomer generation having already started during 65, the number is only going to increase.

Around 83% of Americans have a cell phone, and from at least this study by Pew Research, we’re very dependent on them. Intel, in a study of U.S. attitudes toward travel and technology, found that vacationers feel antsy when traveling without their mobile devices and angry when they cannot access power sources to charge these devices. They also feel annoyed when others take uninvited glimpses of their computer screens, potentially compromising their personal information….Survey respondents, moreover, ranked losing these devices when traveling as more stressful than losing their wedding ring.

In summary, there are many Americans with a chronic disease who are regularly using mobile devices for any number of reasons. So how does this relate?

A few weeks ago, New England Health Institute (NEHI) identified 11 emerging technologies that could have a positive impact on chronic disease by improving care and/or lowering costs. The list includes

• Tele-stroke care
• Virtual visits
• Mobile asthma management tools
• In-car telehealth
• Extended care eVisits
• Mobile clinical decision support
• Medication adherence tools
• Social media promoting health
• Mobile cardiovascular tools
• Home telehealth
• Mobile diabetes management tools

While this sounds wonderful, an article in the July Scientific American “How to Fulfill the True Promise of “mHealth” Mobile devices have the potential to become powerful medical tools,” the author Francis Collins notes, I am convinced, however, that the real potential of mHealth lies with much more committed users, such as the children with type 1 diabetes who took part in a yearlong, case-control study of wireless technologies to monitor and manage blood glucose levels. ….Youngesters who used the automated system had significantly better glycemic control and diabetes self management skills than those who did not.”

Going to a satellite clinic where the person is hooked up to a device that transmits health data 1,000 miles away to a specialist, is a good use of mobile technology, that in one form or another, has been in place for decades. Medical providers, who are very wired group, are using them all the time to check information, deciding treatment modalities etc. However, persons with a chronic condition keeping a health notebook, or using clinical decision making or medication adherence tools, I’m not so sure about.

I’m skeptical for a variety of reasons: Google tried an on-line free health notebook, but dropped it due to lack of utilization. Eight years prior to Google’s attempt, we launched a print version of a health notebook and found that while caregivers appreciated it, those living with a chronic condition, not so much. Finally, I’ve written a number of posts on this blog about Being an E-Patient and Managing Health Information and they are not that popular

I’m the first to admit that I could be totally wrong about what people with chronic conditions might find useful to help them live well. So this week, I’m asking readers to take a few minutes and complete a survey, which you can e-mail to me at and I’ll report my findings in the coming weeks. All results will be kept anonymous.

MHealth Survey
• Using the numbers 1 (never), 2 (sometimes), or 3 (frequently) how often do you use the internet for the following:
- Support from others living with similar condition
- Finding health information
- Being an E-patient-sharing your health data at sites like “Patients Like Me.”
- Communicate with your provider via e-mail
- Maintain personal health record
- Re order prescriptions
- Other (specify)

• Do you have access to Apps?
- If yes, have you downloaded health related ones?
- What types of Apps are they?
- If yes, how often do you use them? 1 (never), 2 (sometimes), or 3 (frequently)
- Do you fine they have had an impact on your health or sense of well being?

• What type of on-line devices do you think would help you to manage your condition?

Wednesday, June 20, 2012

Take a Break: Try Nordic Walking/Riddle

Living in VT, people try all sorts of ways to stay fit for their favorite winter sports in the off-season. It’s not uncommon to see people with ski poles and roller blades speeding down the sides of roads and even highways. Several years ago, I started experimenting using my cross-country poles for walking. I found that I really liked it and that it actually made things easier on my body. While I used poles for snowshoeing, I also found they made it possible for me to take walks around the icy roads in my neighborhood during the winter, and made hiking in the mountains much easier.

I put the poles aside for swimming, biking and working out at the gym. I just recently started using them again and I checked out poles at a sporting goods store. In truth they weren’t much different than the poles I have. Further, my husband informed me that I haven’t been using the straps on my current poles correctly. Maybe I will eventually purchase new poles, since they have some that are very light and fold to fit in a suitcase. However, you don’t need to invest in a lot of money for this activity.

For me there is nothing like learning something new, and how much better when it’s something that’s really good for you? According to the American Nordic Walking Association, Many doctors agree that Nordic walking is one of the most effective cardiovascular workouts because it works all major muscle groups in the body. Recent studies by the Cooper Institute, Dallas, showed that Nordic walking burned more calories, increased oxygen consumption, and can be up to 46% more efficient than normal walking. Nordic walking is also great for weight loss. By using the Nordic walking poles, you increase your heart rate on average 10-15% more than normal walking. This means you can burn well over 400 calories per hour, much more than normal walking, which only burns approximately 280. An additional energy consumption of 1500-2000 calories a week while doing physical activities reduces your risk of getting sick. You can achieve this by walking with your poles approximately 3 hours every week.

Nordic Walking, sometimes called pole walking, is being recommended and studied in groups of people with chronic disease, including those with Parkinson’s Disease. It’s also thought of as a good exercise to prevent chronic disease.

There are some good tutorials on-line that can help you with the basics. I found the on-line video Nordic Walking-An Introduction & How To very easy to follow. While it appears that this type of walking is more popular in Europe and Australia, it’s starting to pick up in the United States. The best way to find a group near you is to go on-line and put your location with “Nordic walking” and see what comes up. Chances are good there are places near your home.

Not up for walking today? How about a 9-letter word riddle?

What nine-letter word in the English language is still a word when each of the nine letters is removed one by one? Take a few minutes to try and come up with a nine-letter word that fits the bill, and then watch the video for the answer.

Saturday, June 16, 2012

Making Healthy Changes That Stick: Part II

In follow up to last week’s post on Making Healthy Changes Part I, this week we focus on specific habits you may want to change and have stick.

Medications: One of the most important things for people with chronic conditions that require medications, such as diabetes, is to consistently take them. Since between 20 and 25 percent of Americans don’t adhere to their medication regiment, this is a serious problem. Some things to try:
• Contact your condition specific organization (e.g. American Diabetes Association) and ask them for their “tip sheets” or other resources to help you stick to your meds.

• Financial concerns are very real, so talk to your medical provider if this is impacting your ability to adhere to your treatment. Most states offer some type of program, and you can also check out some of these links:
- Prescription Assistance Program
- Free Medicine Program
- Needy Meds
- Rx Assist
- Together Rx Access
- Tricare Senior Pharmacy For uniformed services beneficiaries 65 years of age or older.

• If you are having side effects, talk to your provider about switching treatments and/or contact the condition specific organization about strategies that might help.

• Join a support group so that you can learn strategies to help you and so you can help others.

Smoking: While I know a man that stopped smoking with the one thought, “why should someone make money off of killing me,” this is generally not the way for most people. In the US, each state has its own tobacco control program, which offers a variety of free ways to quit smoking. Go to the Centers for Disease Control for links to your state’s program. Since I live in Vermont, check out the VT Quit Network.

Weight Loss: According to US News, the best diet plan is Weight Watchers. There are now programs available for men. Many hospitals and health centers offer Weight Watcher groups, as well as programs like TOPS (Taking Off Pounds Sensibly).

If you can afford it, some people do very well by going to a weight loss retreat, such Fox Run.

Talk to your provider and/or condition specific group about weight loss. Many health centers and hospitals offer free programs for weight loss and nutrition based on condition.

Alcohol and Drug Dependence: Twelve step programs, such as Alcoholics Anonymous and Narcotics Anonymous are free and available just about everywhere. For many this is considered “the gold standard.” However, there are other types of programs you can try:

SMART Recovery Self-empowering addiction recovery support group. Our participants learn tools for addiction recovery based on the latest scientific research and participate in a worldwide community, which includes free, self-empowering, science-based mutual help groups.

Moderation Management: This is not an abstinence based program and is designed for those who want to reduce their drinking and make other positive lifestyle changes.

Medications: There are medications that can help with alcohol abuse and dependence (Disulfiram, Naltrexone and Acamprosate) as well for opioids (methadone, burprenorphine and naltrexone). These are prescription medications, so you will need to work with a licensed physician and take regular tests, sometimes weekly.

Women for Sobriety

• Residential treatment can also be very effective. Therapeutic communities, where a person stays for 6 to 12 months, or even longer, are In general, drug-free residential settings that use a hierarchical model with treatment stages that reflect increased levels of personal and social responsibility. Peer influence, mediated through a variety of group processes, is used to help individuals learn and assimilate social norms and develop more effective social skills. Learn more about Treatment Communities of America.

Wednesday, June 13, 2012

Take A Break: Make a Wreath and Other Tie Crafts for Father’s Day

Since this coming Sunday is Father’s Day, a fun way to celebrate is to repurpose old ties. You can start by making a wreath.. Because it’s vine season here in Vermont, you can make a wreath form by wrapping the vine around in a circle. Of course, cheap Styrofoam forms are available at the Dollar Store and you might even have something tucked away in the Christmas decoration box.

The simplest way to do this is to take the tip of the tie (the tongue portion), lay it over the wreath form so it extends slightly and cut it so you have enough length to cover the wreath form and tuck it under the tongue. Work your way around and finish with a tie ribbon or even a tie flower. You’ll need about 12-14 ties for this project. Check out the Tie Wreath from Good Housekeeping.

My local thrift store doesn’t have 14 ties, let alone ones that are fairly decent, so a better approach for me is to try one of the following projects that take fewer ties.

• Use a Styrofoam cone shape and use the fronts of several ties, lengthwise, to make a mini topiary.

• Make a flower centerpiece from Old Ties: Use this site to make a variety of types of flowers. Put several together and make a lovely centerpiece for Dad’s special dinner.

Turn a necktie into a bow tie.

• Use origami to create a bow tie. Take an old tie and undo it so you have a piece of fabric. You can do one of two things, dip it into liquid starch, let it dry, iron so that it’s the stiffness of paper and fold the bow tie using origami instructions. The other option is to cut out a rectangle 2.6 inches by 6.1 inch (the shape of a US dollar bill) and iron light weight fusible webbing (sometimes called Under Wonder) to the back and follow origami instructions. You can use a clip-on if the gent wants to wear it.

• Check out Artful Ties for a variety of projects with neck ties, including a chair.

So if a tie project isn’t something that interests you today, check out some fun videos made from Legos.
Monty Python Knights of the Round Table

The Simpson’s Intro Lego style

The Fastest and Funniest LEGO Star Wars story ever told

Other ideas for Father’s Day
Do Something for the Dad’s

Saturday, June 9, 2012

Making Healthy Changes That Stick: Part I

Exercise, diet, stress management, and taking meds as prescribed are all really good and important things to do, but how many of us stick to them religiously? If any of these comments sound like something you’ve said or think, this post and next weeks are for you:
“I’ll go to the gym tomorrow.”
“My diet starts after the first of the year.”
“It’s my son’s (substitute friend, Mom, co-worker) birthday, so it would be bad form not to eat a slice of their cake.”
“They can’t possibly believe that people will take these medications everyday.”
“It’s just one drink.”

So what’s the secret to making changes, like modifying your diet and sticking to it?” Truth is, if there was one sure fired way, we would all be modelicious.

Different strategies work for different people and at different times in their life. When I was in college, every gal I knew seemed to be on a diet of one sort or another. It was the “in-thing” to be on the low, no carb diet. Since we like to “fit in,” were looking to find a mate, and we walked quite a few miles a day just to get to all the different buildings for class, it was no problem keeping a trim figure. Three kids later, the advent of computers, work and a slower metabolism, not so much with the trim and slim bode these days. Yes, many people I know are on the low carb diet, but since we’re in a very different mind set at this stage of life, the results aren’t quite the same. In short, what worked at one time doesn’t necessarily work later on down the road.

Is it harder to make the change or sustain it? The short answer is that it depends on the person and the situation. For someone with a drug addiction, getting clean may be the hardest thing they’ve ever done. I’ve known more than one person that has said it was so hard getting clean they wouldn’t dare do anything to jeopardize their sobriety. However, for others, such as weight loss, the problem wasn’t the taking it off, it was the keeping it off.

Take heart though, change, and sticking to it, is possible. Consider the following:

• If you feel deprived you wont stick to a change for too long. Figuring out ways to reward yourself to stay with the change is one way. I know two friends that have lost considerable weight recently by building in a reward for themselves every day. Both adore chocolate, so they have built in a daily reward of low carbohydrate very dark chocolate. As it turns out dark chocolate in the amounts they are eating is actually good for their health.

• For long term sustained change, work on implementing a behavior that you find as satisfying or better than the one you are giving (gave) up. If you are stopping smoking, replacing a different activity during the times you normally smoked will help increase the likelihood you’ll stay smoke free. For example, one person found eating pretzel rods (reminded them of holding a cigarette and they loved licking the salt off of them) helped.

• The change has to be one you believe in. You know that exercise is something you need to do, so you decide to go swimming three times a week after work. However, not being all that wild about swimming, let alone hating the “wet hair,” is pretty much a guarantee that this behavior change wont last much beyond a week or two. Instead, consider options that fit with your schedule and that you enjoy. For example, thirty minutes of exercise spread throughout the day is as good as getting it done all at once. Parking 10 minutes away from your office gives you 20 minutes of exercise right off the bat as you need to walk to and from each day.

• Living in the present can help you make and sustain change. Thinking that you have a life time ahead taking insulin or another medication can be way too much. Reminding yourself that you only can live in the present moment, and that’s all that required, can help to break things down to manageable and achievable levels.

• Letting key family and friends know that you are trying to make a change can be helpful if they are willing to support you in the changes you are making. However, if you suspect they may try to sabotage the effort, or make fun of you if you slip up, they don’t need to know.

• Use the buddy system. Someone that you can go to the gym with, report your weight to or call when you want a drink can go a long way to keep you on the path to making changes and sustaining them. What’s great about the buddy system is they are helping you while you are helping them.

• Watch out for triggers. A morning cup of coffee can be a trigger for having a cigarette. Stopping at a particular store to purchase a book, can be cause to buy your favorite candy bar. Changing patterns surrounding the habit you are trying to change can be very helpful.

Next Saturday’s post will deal with tailored strategies for different habits you may wish to change and keep.

Wednesday, June 6, 2012

Take a Break: Celebrate Bonza Bottler Day

So who knew that when the day of the week is the same number as the month, it’s Bonza Bottler Day?

Today is June 6 or 6-6, so happy Bonza Bottler Day. This custom is now over 25 years old. August 8, 2010 marked the 25th year anniversary of the first official celebration of Bonza Bottler Day, which was created by Elaine Fremont in 1985 when she realized there were no special occasions to celebrate one month. She decided to give herself a reason to have a party and some fun with this special day every month. Ms. Fremont held a contest to name the day, which a student from Australia won. When Australians like something, they might exclaim, "Bonza !" which means "super," "great," or "fantastic." "Bottler" is slang for "something excellent." Thus, the celebration each month is now known as Bonza Bottler Day, which was first officially celebrated on August 8, 1985 in Greenville, South Carolina, where Elaine Fremont was born and lived.

Any excuse for a party works for me.

According to the official Bonza Bottler Day website, you can start the day by greeting friends, family, fellow workers and random people on the street with, “Happy Bonza Bottler Day.” This could be the perfect reason for trying out a new restaurant or giving yourself a special treat, or doing something nice for someone on this day each month. Of course there is The Bonza Bottler Day Store where you can order mugs, note cards, buttons or whatever else.

This year the June Bonza Bottler Day falls on “Cake Day.” Make a cake and decorate it with Bonzy, the Bonza Bottler Day Ground Hog. If you don’t want the bother of making a cake, you can always decorate one virtually and e-mail your Happy Bonza Bottler Day wishes. Good site to bookmark for birthdays.

Saturday, June 2, 2012

Take Care of Your Brain

“Iron rusts from disuse; stagnant water loses its purity and in cold weather becomes frozen; even so does inaction soften the vigor of the brain.” Leonardo da Vinci was on the right path when he wrote about what happens to our brain if we don’t use it. Ongoing research is showing that a healthy brain makes us feel better and can keep problems, such as dementia, at bay.

When living with a chronic disease, medications, stress, to say nothing of the disease itself and/or age, can contribute to how effective, or ineffective the brain functions. Since changing the brain changes how we feel, it’s important to take care of those 100 billion cells, most of which are neurons.

Neurons are like a light switch; they can be in a resting state (off) or shooting electrical impulse (on) down a wire. Each of the billions of neurons “spit out” chemicals that trigger other neurons. Different neurons use different types of chemicals. Neurons do not act alone; rather they are connected to many other neurons.

The brain is a complex beast to put it mildly. Maybe the easiest way to understand it is to think of your brain like an orchestra. If everyone shows up, is in tune and playing together, you get beautiful music. However, if someone is late in the cello section, the cymbals player isn’t paying attention, the flutist is eyeing the cute French horn player, not the conductor, and the first violinist has a raging cold, it wont be long before the “sweet music” turns quite sour.

The old theory was that you were born with so many neurons and as you aged, had an injury etc., they died never to be replaced. It was also believed that neural pathways once destroyed could never be repaired. However, recent research shows that the brain has a lifelong ability to reorganize new neural pathways based on new experiences. For example, in response to a brain injury, the brain can form new connections to compensate for lost function and/or to maximize remaining functions in the brain. Parts of the brain are also generating new neurons all the time to help with those connections.

Dr. Daniel J. Siegel, clinical professor of psychiatry at the UCLA School of Medicine and Co-Director of the Mindful Awareness Research Center, has come up with a “Healthy Mind Platter” to correspond with the “Choose my plate” strategy. The latter replaced the food pyramid for healthy eating by US Dept. of Agriculture. Siegel suggests seven mental activities to optimize brain and create well being.

Focus Time: When we closely focus on tasks in a goal-oriented way, we take on challenges that make deep connections in the brain.

Play Time: When we allow ourselves to be spontaneous or creative, playfully enjoying novel experiences, we help make new connections in the brain.

Connecting Time: When we connect with other people, ideally in person, and when we take time to appreciate our connection to the natural world around us, we activate and reinforce the brain's relational circuitry.

Physical Time: When we move our bodies, aerobically if medically possible, we strengthen the brain in many ways.

Time In: When we quietly reflect internally, focusing on sensations, images, feelings and thoughts, we help to better integrate the brain.

Down Time: When we are non-focused, without any specific goal, and let our mind wander or simply relax, we help the brain recharge.

Sleep Time: When we give the brain the rest it needs, we consolidate learning and recover from the experiences of the day.

If it’s good for your heart, it’s probably good for your brain. According to the Alzheimer’s Foundation, Many experts believe that controlling cardiovascular risk factors may be the most cost-effective and helpful approach to protecting brain health. Therefore, in addition to Siegel’s seven strategies, which include those heart healthy favorites of stress reduction and exercise, incorporate heart healthy foods.

According to WebMd, research is showing that you can increase your chances of maintaining a healthy brain well into your old age if you add these "smart" foods to your daily eating regimen. Blueberries; wild salmon; nuts and seeds (walnuts, hazelnuts, Brazil nuts, filberts, almonds, cashews, peanuts, sunflower seeds, sesame seeds, flax seed, and unhydrogenated nut butters such as peanut butter, almond butter, and tahini); avocados; whole grains; beans; pomegranate juice; freshly brewed tea and dark chocolate.

Another important strategy is protecting the brain from injury. Wear a helmet when engaging in sports such as skiing, snowboarding, cycling, motorcycle riding etc.; avoid falls; and wear a seat belt in the car.

In the May issue of the Mayo Clinic Proceedings, a study found that in 926 people, 70 years of age or older, those who engaged in moderate levels of exercise, like brisk walking, yoga, aerobics, or tennis, along with regular computer use, reduced the odds of developing mild cognitive impairment. Engaging the brain in “mental aerobics” most likely engages neurons that physical exercise doesn’t touch.

According to the Alzheimer’s Association, Mental decline as you age appears to be largely due to altered connections among brain cells. But research has found that keeping the brain active seems to increase its vitality and may build its reserves of brain cells and connections. You could even generate new brain cells.

Activities such as reading, learning a second language or something new, cross word or other types of puzzles, playing games etc. can all help with mental stimulation. For fun and brain exercise, check out AARP's free game website.