Geriatrician, Hospitalist, Patient Advocate, Healthcare Educator

Keep Your Mind Sharp

Photo by Júnior Ferreira

How many times have you forgotten your key, wallet, or cell phone? It can be frustrating but is a normal part of life. Our brains are multitasking every second of the day for us to function the way we do. With age though, there are changes that occur. Blood flow to the brain decreases, certain parts of the brain shrink, and there is decreased nerve transmission.

Sometimes, it becomes difficult to find words and recall names or have issues with multitasking. Does that mean someone has dementia? Absolutely NOT! It not necessary that everyone who is not as sharp as they used to be has dementia. Dementia is something that is diagnosed after careful considerations of alternative diagnosis and detailed evaluation.

Much research has been done to find ways to keep our minds “sharp” as we age, here are some habits to foster:

Eat Healthy

  • Antioxidant rich foods (berries, red grapes, carrots, spinach, dark chocolate, green tea, coffee, red wine)
  • Eggs (contain brain nutrients- B6, B12, folate, and choline)
  • Salmon (omega-3 fatty acids)
  • Nuts
  • Mediterranean diet (Annals of Neurology)

Staying Active

  • Games (Sudoku, chess, board games, watching brain stimulating shows/game shows)
  • Read and write
  • Learning something new (cooking, knitting, photography, gardening, other hobbies) (American Academy of Neurology)
  • Meditation
  • Exercise (working out prevents brain inflammation, increases blood supply to the brain, and also increases a protein called brain-derived neurotrophic factor (BDNF), which is needed for growing and keeping neurons) (Science Daily)
  • Socialize (socialization engages multiple brain areas) (Journals of Gerontology)

Self Care

  • Sleep adequately (sleep problems lead to issues with memory and concentration)
  • Stress relief (listen/play music)
  • Manage underlying conditions well (keep blood sugars and blood pressure under control, take your medications)

A little can go a long way… try to work on keeping your mind healthy. Remember what we don’t use, we lose. We have to use and challenge our brains everyday!

Is Coffee Good for Me?

Photo by Mike Kenneally

Coffee has become the main part of the morning routine in most American households. When I think of coffee, I think of caffeine. It gives that extra kick for the start of the day. Besides caffeine, coffee has many components including polyphenols, B vitamins, potassium, and riboflavin.

There has been much talk and research on the pros and cons of coffee intake. There was a large prospective study published in New England Journal Of Medicine in 2017 which showed significant inverse associations of coffee consumption with deaths from all causes and specifically with deaths due to heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections.

Here are some of the benefits of coffee consumption:

  • Reduces reaction time and improves alertness
  • Increases metabolic rate, helps to burn more calories and has been associated with having a lower body weight
  • Decreases breakage in DNA strands
  • Allows the body to process glucose better therefore reducing the risk of developing Type II diabetes
  • Some research indicates that women age 65 and older who drank two to three cups of coffee a day were less likely to develop dementia
  • Decreases risk of colorectal cancer
  • Improvement in memory, mood, and mental function
  • Reduction in risk of developing gall stones and Parkinson’s disease
  • Lower stroke risk
  • Contains polyphenols (inhibit the growth of cancer cells as well as lower the risk of Type 2 diabetes)
  • Contains antioxidants, which have anti-inflammatory effects

Limit your coffee intake in the following conditions:

  • Pregnancy and lactation - caffeine gets metabolized much more slower so it can take longer to eliminate caffeine from the body thereby causing accumulation. Caffeine also crosses the placenta into the fetus. Some studies have shown that it can increase the risk of miscarriage, low birth weight and premature birth therefore it is important to consult with your doctor right away

  • Anxiety (caffeine can worsen symptoms)

  • Elevated heart rate or cardiac arrhythmias

  • Sleep disturbance-drinking coffee later in the day can make it harder to fall asleep and also affects quality of sleep

So now we do not have to feel guilty of getting our morning joe in or that afternoon cup of bliss. Drinking two to five cups of coffee a day reduced mortality in studies, so you may actually doing yourself a favor. Like most things though, everything is good in moderation, including coffee, do not overdo it, but enjoy that cup of coffee!


How much caffeine does one cup of coffee contain?

  • One cup of coffee on an average has about 95 mg of caffeine

How much caffeine is too much?

  • Per the FDA, a healthy adult can consume about 400 mg/day. This translates to about 4-5 cups of coffee.

How do I decrease the calories I consume with my cup of coffee?

  • Try to cut down on the add-ons such as half and half, whipped cream, sugar. Try cardamom, cinnamon, mint leaves, or lemongrass in an attempt to limit sugar intake.

Should I Get an Activity Tracker?

Photo by Andres Urena

It seems so easy to gain weight with age (especially with the pandemic and inactivity). I tried to up my activity, watched what I ate, and tried to envision a more healthier version of myself. I pondered getting an activity tracker to get an accurate step count and to be able to see my calorie burn. There are various activity trackers on the market which provide a wide array of features so it’s important to find one that fits your budget and has the aesthetic appeal and features you need/want. I ended up getting a Fitbit. After using the Fitbit over the past few months, I can say, it has been a good tool for me. I was impressed that Fitbit has allowed me to keep track of so much more than I imagined. Here’s a quick summary of what I liked about my experience with the Fitbit:

  • It was easy to set up and download and sync the Fitbit app
  • Good battery life (I charge it about once a week, more frequent if you use the GPS)
  • Step count with miles you have walked
  • Sleep duration and stages of sleep with a sleep score
  • Auto tracks exercise
  • Active zone minutes
  • Activity reminder (alerts you to at least take 250 steps an hour for a period of 9 hours)
  • Calorie expenditure
  • Track water intake
  • Track food intake
  • Allows you to log your weight, see your BMI and trend it
  • Tools and apps (Mindfulness, various videos, weather, Spotify, timer/alarm)
  • A weekly summary on the app and email
  • Allows you to link with friends and family

Active zone minutes is the feature I love the most. It has helped me gauge what exercise works the best for me. It tracks your heart rate in fat burning, cardio, and peak zones. 1 active zone minute is given for fat burn and 2 active zone minutes for cardio and peak zones.

Overall, it has been a good experience for me to see what exercise routines get my heart pumping and are effective so that I can achieve my fitness goals. One should consider getting an activity tracker if they are looking for an easier way to monitor their fitness and lifestyle choices. Getting a weekly summary of what I have achieved not only motivates me to continue what I am doing well, but also improve on other parameters. If nothing more, I am now accountable and try to do better because of that. Whether you get an activity tracker or not, work on becoming that better, healthier, and fitter version of yourself.

Protecting Yourself in the Sun

Everybody likes a nice sunny day. It brings about a good mood, a feeling of well-being, and overall a positive take on the day. Being outside can allow for physical activity, a dose of vitamin D, and reduce stress. However, the warm rays of the sun also cause damage. The sun produces ultraviolet rays which are an invisible form of radiation. There are three types of UV rays produced by the sun: UVA, UVB and UVC. UVC rays have the shortest wavelength of the three and are absorbed by the ozone layer before reaching Earth and therefore not of significance to us.

Medium wavelength UVB cannot penetrate beyond the superficial skin layers. It is responsible for delayed tanning, skin burn, enhanced skin aging and is associated with skin cancer. UVB accounts for about 5% of UV rays reaching the ground as most solar UVB is filtered by the atmosphere. Long wavelength UVA accounts for approximately 95% of the UV radiation reaching the Earth’s surface. It penetrates the deeper layers of the skin and is responsible for the immediate tanning effect, premature skin aging, sunspots, wrinkles, and the development of skin cancers.

Here are some of the ways to protect ourselves while enjoying the sun:

  • Sunscreen or sunblock - Apply to your face and body about 30 minutes before going out in the sun to allow it to bind to your skin and make sure you re-apply every 2 hours if you remain in the sun as sunscreen does wear off

  • Sunglasses - protect the skin around your eyes from UV damage and also reduce the risk of cataracts

  • Clothing - try to wear long sleeved shirts or long skirts or pants, darker clothes may provide more protection, look for clothing certified as providing UV protection

  • Hats - wear a hat that has a brim that shades your face and neck

  • Shade - find areas of shade if possible if remaining outside for long periods

Sunscreen is one of the most important things that we can do to protect our skin from photodamage. Sunscreen serves as a chemical defense that absorbs the UV rays before they damage the skin layers. When choosing a sunscreen, we often look at the SPF, or Sun Protection Factor. This is a measure of how well sunscreen protects against UVB rays, not UVA. Sunscreens that provide SPF 15 or SPF 30 are recommended. Interestingly, sunscreens with higher SPFs, such as SPF 75, do not provide significantly greater protection than SPF 30. An SPF of 15 filters out about 93% of UVB rays, compared to 97% for SPF 30. Darker skin types can use a lower level, such as SPF 15, since they have more melanin in their skin, which does give some protection. However, although darker skin may not sunburn as easily as those with fair skin, they are still at risk of skin damage from sun exposure. If your skin changes color after 10 minutes of unprotected sun exposure, then SPF 15 will allow a factor of 15 times more before skin burn occurs so about 150 minutes (SPF 30 will allow a factor of 30 times more in this instance so about 5 hours to prevent sun burn).

Sunscreen Q&A:

When should we wear sunscreen?


Even when we stay home all day or it’s cloudy outside?

Yes. UVA rays can penetrate through clouds, clothing, fog, and glass including windows. A simple car ride to the grocery store or sitting at your breakfast table sipping coffee can cause skin damage.

Which goes first? Sunscreen or bug spray?

Apply sunscreen first! Let it absorb into your skin and then apply insect repellent.

What SPF Sunscreen should we apply to our skin?

SPF 15 or higher. It is important to understand that the best sunscreen is not always the expensive one. What is important is that it provides broad spectrum coverage (meaning coverage against both UVA and UVB) and is at least SPF 15.

Staying Hydrated in the Summer

With Covid declining and everyone rushing outside to enjoy our new found freedom, drinking enough water is a struggle. After all our bodies are composed of about 60% of water. How much water you need depends on the weather, activity status, if you have medical conditions, and what foods you ate that day (some foods contain larger water content than others).

Although most experts recommend eight 8 oz glasses of water a day, the needs of each individual varies. A simple way to calculate how much you should drink is to divide your weight in half, that is how many ounces a day your body requires. For example someone who weighs 200 pounds should be consuming 100 ounces of water a day on an average.

We all lose water throughout the day, the main purpose of drinking water is to prevent dehydration. Often, health conditions or medications such as being on a diuretic can cause further water loss. Those living in hot weather who are out in the sun, undergoing vigorous workouts, or eating salty, sugary, or spicy foods will require more water to compensate.

For the most part our bodies know when we need to drink more water and can stimulate the thirst mechanism. Unfortunately in the elderly, the thirst mechanism may be impaired making them more prone to dehydration.

Benefits of water hydration:

  • Drinking water can cause a slight increase in metabolism, drinking water about a half hour before a meal will cause someone to eat lesser calories and therefore may help in weight loss
  • Skin becomes clear, plumper with improved elasticity with good hydration
  • Helps maintain body temperature (as we feel hot and sweaty, drinking water cools down the body)
  • Helps in digesting food effectively and prevents constipation
  • Delivers oxygen throughout the body and improves circulation
  • Helps kidneys work efficiently, prevents kidney stones
  • Allows the bladder to flush out toxins therefore preventing urinary tract infections and also helping in treating urinary tract infections
  • Helps lubricate and cushion your joints, brain, spinal cord
  • Prevents headaches and migraines (dehydration causes your brain to shrink and pull away from the skull triggering pain receptors and therefore causing a headache)

Helpful tips for consuming more water:

  • Get a reusable water bottle or jug to keep count of how much you are drinking or invest in a smart water bottle
  • Enhance water with fruit, lemon, cucumbers, or mint
  • Try to add water or ice to sugary drinks such as juices
  • Use an app to record water intake to keep yourself accountable
  • Eat water rich fruit and vegetables such as watermelon or cucumbers
  • Keep a water bottle or jug around you even when you are working and keep refilling it
  • Eat spicy food! This will sure make you want to chug down some water.
  • Freeze freshly squeezed lemon or lime into ice cubes


What are some symptoms of dehydration?

Mouth feels dry and parched, urinating less, dark yellow color urine, feeling tired/dizzy

Can my urine tell me if I am dehydrated?

Yes. Normal urine should be light yellow. If it is dark yellow, it means you are dehydrated and need to drink more water. On the other hand, if your urine is translucent with no color, it may mean you are drinking too much water.

How do I take care of my reusable water bottle?

Wash it with soap and water every day and make sure it is dried before using it again. If it is dishwasher safe, you can run it through the dishwasher ensuring it is dried thoroughly to prevent germs.

I'll Have That Salad!

Have you ever passed on a salad for something more substantial? What we need to be aware of is that we are passing on something that is actually really good and nutritious for something that likely is not. A salad is generally known as mixed greens with a dressing. Salad is a term that originates from the Latin word “sal” which means salt, which is often an ingredient in the dressing. As far as the history is concerned, we know that salads were enjoyed by ancient Romans and Greeks. Aristotle first mentioned the health benefits of swiss chard in the 4th Century BC. It was around 1894 that iceberg lettuce was developed. The Caesar salad was created by Caesar Cardini, an Italian chef likely in 1924. It was in 1939 that a restaurant in Chicago opened the first salad bar. Since then, salads are served all over the world as appetizers, side dishes, and entrees.

Researchers have noted a link between eating lots of fruits and vegetables and lower risks of many diseases, particularly cancer. Salads are a good way to get those 5 servings of fruits and vegetables a day. The base of a salad is composed of a base of greens, be it iceberg lettuce, romaine lettuce, kale, arugula, or baby spinach. The green leafy vegetables contain nutritional benefits of fiber, vitamins, minerals, and phytonutrients. Foods with phytonutrients have antioxidant and anti-inflammatory benefits. Vitamins and phytonutrients are nutritionally dense and may naturally increase your metabolism. Here are some of the ingredients you can incorporate in your salads to reap the benefits:

Ingredient Benefits
Lettuce Natural source of fiber which helps to reduce bad cholesterol (LDL), helps with weight loss, helps control blood sugar
Tomatoes Contain lycopene which helps clear free radicals in the body
Carrots Loaded with vitamin A and beta-carotene, help keep blood sugar levels under control
Bell pepper Red is the most nutritious. Compared to green bell peppers, the red ones have almost 11 times more beta-carotene and 1.5 times more vitamin C
Broccoli Source of anti-cancer enzyme sulphoraphane
Avocado Help absorb protective compounds, phytochemicals, and lutein. Also raises HDL(good cholesterol) and lowers LDL(bad cholesterol)
Fruits (apple or pear slices, strawberries, blueberries, cranberries, pomegranates) Full of vitamins
Nuts and seeds (sunflower seeds, chopped walnuts) Good source of nutrients and antioxidants
Protein (eggs, meat, beans, edamame)
Dressing (olive oil, herbs, spices, vinegar, lemon, lime, ginger)
Herbs (basil, parsley, oregano) contain antioxidants
Super sprouts Adding sprouts to salad adds to the nutritional value of your veggies

Now a word of caution, although salads are generally felt to be healthy, it is easy to make it unhealthy. Be mindful of the calorie content on salad dressings in particular. You may want to make a salad dressing at home instead. By adding too much salad dressing, croutons, or cheese, we can load on those calories.

Next time when deciding on a meal, pick a healthy, colorful, and visually appealing salad. It can be hard to choose a salad over other favorites but find ways to incorporate salads into your diet such as making ‘to go’ mason jar salads for lunch or hosting salad competitions. May, National Salad Month, is the perfect time make the effort to eat that salad!

Laugh a Little More

A day without laughter is a day wasted

Charlie Chaplin

It is often said that laughter is the best medicine. Do you remember the last time you really laughed, whole heartedly with heart and soul?  The average adult laughs about 15 to 17 times a day whereas children laugh a lot more. The health benefits of laughter are numerous, and it is one of the easiest things to do.

It was Dr. Madan Kataria, a physician in India, who developed an exercise known as laughter yoga in the 1990s and is the founder of the worldwide Laughter Yoga movement. Laughter yoga is a modern exercise involving prolonged voluntary laughter. This type of yoga is based on the belief that voluntary laughter provides similar physiological and psychological benefits as spontaneous laughter. Dr. Kataria created World Laughter Day on May 10, 1998. Since then, World Laughter Day is celebrated every year on the first Sunday of May to raise awareness of the multiple health benefits of laughing. Some of these benefits include:

  • Strengthens immune system
  • Improves blood flow and the function of blood vessels which help protect us against cardiovascular disease and heart attacks
  • Helps burn calories
  • Reduces stress level and relaxes the body
  • Diminishes pain
  • Improves overall mood as it releases endorphins, our body’s “feel good” chemicals
  • Promotes bonding between groups and individuals

Laughing is a natural part of everyday life but we need to do more of it to actually get the benefits it can offer. So, what can we do to bring more laughter into our lives? We can smile more and gravitate towards things that make us happy. Here are some ideas:

  • Spend more time playing games be it cards, board games, or along with TV game shows
  • Watch funny movies, TV shows, or videos online
  • Gravitate towards people who are laughing and playing such as kids
  • Play with your pets
  • Bring humor into your conversations
  • Take part in activities you may like such as bowling, karaoke, playing or listening to music
  • Create something you love and brings pleasure to you, it will surely make you smile-an art piece, knitting, new dish to try
  • Check out a laughter yoga class near you or on YouTube
  • Don’t be afraid to laugh at yourself

Take a mental note of what will make you smile and laugh and do more of it!

10,000 Steps a Day - Really?

There is a lot of hype about reaching a goal of 10,000 steps which translates to about 5 miles for most individuals in a day - easily trackable if you are using a smartphone app or wearable fitness tracker. The average American walks around 3000 to 6000 steps a day. Now, although it is a good goal, it may be unrealistic due to time constraints related to schedule or perhaps physical incapacity such as arthritis.

There is no real scientific basis why 10,0000 steps is recommended. So how did this number come about? In the mid 1960s, a Japanese clock company created a marketing campaign for a pedometer called the Manpo-kei(which translates to 10,000 steps). The 1964 Tokyo Olympic Games had awakened health consciousness and coupled with an obesity epidemic, it was felt this waist step counter would decrease chronic illnesses such as obesity and heart disease. Interesting enough, the Japanese character for 10,000 looks like a person walking also.

What we do know is that with increased activity, there is an overall decrease in chronic illness such as heart disease, diabetes mellitus, hypertension, and metabolic syndrome. It is good to use a step goal to motivate you to do better every day to increase your activity, be it parking a little bit further at the grocery store, taking an evening walk, taking the stairs instead of the elevator, or getting in a more intense work out.

Dr. I-Min Lee and her colleagues studied the validity of 10,000 steps which was published in JAMA Internal Medicine:

In this cohort study of 16 741 women with a mean age of 72 years, steps per day were measured over 7 days. Women who averaged approximately 4400 steps/d had significantly lower mortality rates during a follow-up of 4.3 years compared with the least active women who took approximately 2700 steps/d; as more steps per day were accrued, mortality rates progressively decreased before leveling at approximately 7500 Step

It is important, especially in the elderly population that we encourage whatever activity and step count they can accomplish because the benefit is clearly evident at a lower step count. If you are on a weight loss journey, then 10,000 steps is a good goal - reaching a 10,000 step goal is an excellent step towards achieving this.

Walking is a good exercise which does not require any special equipment except a good pair of shoes. However, keep in mind your own individual goals and health, try your best and don’t overdo it! 10,000 steps sounds like a nice goal, but each person has to take their individual goals and health in mind. More than the 10,000 step goal, the real goal should be trying your best each day to get in a little bit more activity in a way that is enjoyable to you.

Is Sitting Really Bad for Me?

We all know certain things like smoking are bad for us. What a lot of people don’t know is how bad the simple act of sitting is. The average American spends about 6 to10 hours sitting a day. This includes working, computer time, watching television, relaxing, commuting by car, bus, or train. With the global pandemic, more and more people are working remotely and that has dramatically reduced physical activity and in turn increased sedentary time.

What is not spoken too much about are the ill effects of sitting for prolonged periods of time. “Sitting disease” has been described by the scientific community to describe the adverse effects of increased sedentary behavior.

Here are just some of the effect - by no means exhaustive:

  • Metabolic syndrome
  • Muscle weakness
  • Hypertension
  • Diabetes
  • Obesity
  • Heart disease
  • Deep vein thrombosis
  • Anxiety
  • Decrease in metabolic rate
  • Decrease in life span.

If you think by adhering to the recommended amount of activity you are counteracting the effects of “Sitting disease” you are wrong. Exercise does not negate the ill effects of prolonged sitting. Even though we cannot do much about certain sedentary activities such as needing to work at a desk or a computer, making a conscious attempt every day to prevent being sedentary is something that is in our power. Here are some of the things that can be done:

  • Stand or walk every chance you get! If you can talk on the phone standing or walking, do it
  • Look into a standing desk, treadmill desk, or bike desk as an addition to your office space if space permits. If you can work on your kitchen island standing for 30 minutes, take the opportunity
  • Take a break from sitting every 30 minutes or so and stand up and stretch. Set a reminder or alarm if you need to.
  • Listen to an audible book and take a walk instead of sitting down to read a book
  • Get up and walk during TV commercials
  • If you are going to play video games, try to incorporate some active video games

Let’s Get Vaccinated!

As we rush to vaccinate as many people we can, the COVID-19 positivity rates are increasing worldwide. France has entered a third national lockdown in an attempt to save lives and curb the COVID-19 virus. Italy has now made vaccination compulsory for healthcare workers forcing them into unpaid leave if they do not comply.

Here in the United States there has been mistrust and anxiety by many when it comes to vaccination. People are concerned regarding side effects and long term effects that we may not know of. Health care is all about managing risks. The upsides of the vaccinations far outweigh the risks. If there is a chance of not getting sick enough to get hospitalized or die, why wouldn’t we take it?

The United States currently has 3 vaccines that have been approved to use.

Pfizer-BioNTech COVID-19 Vaccine

The Pfizer vaccine currently is approved for those aged 16 and over. It is a mRNA (messenger ribonucleic acid) vaccine. It does not have a real virus, instead, it contains a molecule that instructs cells on how to make a protein. In this case, the cells make a spike protein which is found on the outside of the COVID-19 virus. The immune system then makes antibodies to fight anything with this spike protein. In this way, your body is equipped to fight off the virus if it is contracted. A second dose is required to reinforce this protection in about 3 weeks. Efficacy in the elderly is 94%. Clinical trials have deduced that the vaccine is efficacious against symptomatic disease at about 95% and against severe disease at about 100%. Some of the side effects from the vaccine include flu-like symptoms, chills, weakness, and fatigue which usually subside within 72 hours.

Moderna COVID-19 (mRNA-1273) vaccine

The Moderna vaccine is currently approved for those aged 18 and over, is a mRNA vaccine, and requires a second shot at 4 weeks. It’s efficacy in the elderly is at 86% and against symptomatic disease about 94% and is also 100% against severe disease. Neither the Pfizer nor Moderna vaccines used fetal cell lines during the development or production phases.

Johnson & Johnson Single-Shot COVID-19 Vaccine

The Johnson and Johnson has been approved for those aged 18 and over. This one shot vaccine is a viral vector. In this vaccine, a carrier virus has a coronavirus spike protein added to it which then delivers it to your body. Your cells will take the spike protein activating the immune system to create antibodies. This has been shown to have an efficacy of about 42% in the elderly but it too is 100% efficacious against severe disease.

So which one is better? Which one should I take? All three of the vaccines have 100% protection against severe disease and hospitalization. The answer is that you should take any of the three that are available to you.

We all have to do our part to protect ourselves, our loved ones, and our communities.

Lets get vaccinated!