Experts say it’s worth taking the time to search for the right fit


Change is hard, especially when it comes to health care for you or a loved one. Moving to a new location, switching employer-based health insurance or transitioning to a Medicare Advantage plan can all mean you have to find a new physician.

Finding the right provider can make a huge difference in health and well-being. But many people don’t take the time to do their homework, which experts say can result in missed diagnoses, worse outcomes, unnecessary tests, extra costs or avoidable hospitalizations. Put some time and effort into the search up front, and you (or your loved one) will fare much better over the long term.

“I don’t think the selection of a doctor should be less work than if you’re going to put an addition on your house, says AnnMarie McIlwain, a New Jersey-based patient advocate and CEO of Patient Advocators. “This is your life we’re talking about.”

If you were hiring a contractor, you would get recommendations from friends and neighbors, speak with several prospects and look at samples of prior work, she explains. Taking a similar approach to finding a new physician is the least you should do.

What to Consider When Looking for a Doctor

Suggestions from friends and neighbors are a good place to start your search, according to Dr. Preeti Malani, an internist at the University of Michigan Medical Center. The first step is to make sure the doctor (or nurse practitioner) accepts your health insurance. Your health plan’s website will have a list of participating providers, and you can usually filter by other criteria, such as gender, location, additional training or board certification.

Look at factors like where they went to medical school and their institutional affiliation.

Also, look at factors like where the person went to medical school and their institutional affiliation, since larger medical institutions tend to offer more integrated care, McIlwain says. However, while schooling is important, Malani says it’s not everything — there are great people who train at many different types of hospitals.

For some patients, location is a key consideration. That includes things such as proximity to work or home, accessibility via public transportation or whether a private transportation service, such as  for people with disabilities, will take you there.

Also related to location, some people prefer a satellite clinic in the suburbs or a rural community because it’s less hectic and easier to park than a clinic in the middle of a large city. That might work just fine for healthy people. However, those with more complex medical conditions may fare better at an academic medical center with a larger team of specialists and services; these facilities tend to be located in larger cities.

“Some practices have a pharmacist, a nutritionist or social worker available on the premises. Having someone who works hand in hand with your doctor can help produce better outcomes,” says Malani.

Using Online Rating Sites

After you’ve narrowed down your options, review some of the online rating sites, like YelpVitals or Castle Connolly Top Doctors. But take these rankings with some healthy skepticism, and pay attention to the comments. “Look at who’s writing and what they’re saying,” Malani advises. If comments or ratings are consistent across several sites, it’s probably a more reasonable measure.

A recent University of Michigan National Poll on Healthy Aging found that among adults age 50 to 80, 43% had ever reviewed doctor ratings, 14% had reviewed ratings more than once in the past year and 19% had done so once in the past year.

Among those who looked up ratings more than once in the past year, 67% had chosen a doctor due to good online ratings/reviews and nearly all (96%) thought that the ratings matched their experience after meeting with the doctor.

Among this poll’s group of more frequent users, more than half (57%) reported not choosing a doctor due to poor ratings. The survey found that older adults were typically not offering ratings, but were looking at them. Older adults’ voices aren’t necessarily captured and their needs might be very different than the needs of younger adults, says Malani, who directs the National Poll on Healthy Aging team.

Online rating sites can often clue you in to how efficiently a physician’s office is operated. You can see how long it takes to schedule an appointment, whether appointments tend to run on time or if the doctor is consistently behind schedule. There may be comments about whether the office staff Is friendly and helpful, too. This can be important for anyone needing assistance with forms or other paperwork.

In some parts of the U.S., it can be challenging to even find a doctor who accepts new patients. Over half of physicians surveyed in a 2017 Physicians Foundation report say they have reached a tipping point and plan to make changes to their practices. Many surveyed said they intend to take steps that will likely reduce patient access to their services, which limits physician availability at a time when doctors already are in short supply.

Communication Is Key

It takes time to build a relationship with a new physician, and you need to take charge of managing it, says McIlwain, who matches clients with primary care providers and specialists. When you see a new doctor for the first time, bring a list of key questions and one or two objectives for the visit to help make every second of that interaction count.

“A doctor or nurse with good listening skills who takes enough time to explain and answer questions means better results.”

“You obviously want the (physician) to be maximally responsive, caring and open — not dismissive. Those kinds of qualitative things you can only get at from an introductory appointment,” McIlwain says. Ask yourself if you feel a connection with the doctor and if he or she has spent adequate time getting to know you and your situation. If not, keep looking.

Communication is the most important element of a doctor-patient relationship, Malani says. That may mean the doctor explains something in different ways to help you understand an issue or a timely interaction through an online patient portal or getting your phone call or email returned promptly.

“What’s important is that someone on the care team responds to your concerns,” Malani says. “A doctor or nurse with good listening skills who takes enough time to explain and answer questions means better results.”

You may be comfortable finding a physician on your own. However, there are times when using a patient advocate can help, especially if you move to a new community or need a specific type of specialist.

As a patient advocate, McIlwain acts as the client’s eyes, ears and brain. “You are paying us to go deep with you and to arm you with the information you need to make the best possible choices, and to have the best possible relationships and outcomes,” she says.

McIlwain suggests contacting the Alliance of Professional Health Advocates, a group with a national directory, if you want to work with an expert. Interview several to find a good fit.

As we age, our choice of physician becomes increasingly important. “It’s likely that we will develop some sort of health concerns, whether it’s a chronic health issue or just an acute issue, Malani says. “Keep looking until you’re comfortable with your decision, because you’re probably going to be with this person for a while.”

How one family sought to make everyone happy


One of the biggest challenges for anyone administering an estate is how to distribute what are called its tangible items. Unlike other property which can be easily sold, turned into cash and divided equally, tangible property is unique and often can’t be equally split. Also, its value often can’t be measured by what it could be sold for; a family photo album may have no monetary value, for instance, but great sentimental significance.

So, what should you do if you’ve been given the task to be in charge of divvying up a family member’s estate and it includes assorted tangible items?

The way some families do it is by taking turns selecting which items each will keep, sometimes reversing the order at each round so whoever went first in the initial round won’t get an unfair advantage by going first in all rounds.

The family rejected the often typical system for disbursing tangible items of an estate where family members take turns choosing items.

But let me tell you about a clever way one family dealt with this problem. As an estate planning and probate attorney, I’ve worked with many families over the years. But I’ve never ran into the solution my college friend, Sue, described to me after her mother, Mary Jane, died, and the four children needed to divide things up.

Although Mary Jane’s estate was pretty grand, the method the family used to divvy up the tangible items could be one that other families with much smaller ones could try.

724 Items, Not Counting Linens or Jewelry

After Mary Jane’s death earlier at 93, the executors — Sue and her brother Bruce — created an inventory of the 724 items in her estate that had monetary or sentimental value. (Those are their real first names, but I’m not including their last names to preserve anonymity.) These included furniture, artwork, oriental rugs, cutlery, china, furs, games, a piano and a car.

They didn’t include Mary Jane’s jewelry, books or linens, nor her silver, gold and collectible coins. The four siblings agreed to sell the coins and to deal with the many books, linens and jewelry in a more informal manner after the more significant items had been distributed.

Mary Jane, who the family called “Oma,” and her deceased husband, had received many of the 724 items at their big society wedding in Omaha, Neb., in 1947; purchased others during their long, married life and had inherited others. Many of the inherited items included antiques and boxes from Mary Jane’s mother that had remained in the attic since her mom’s death.

The family rejected the often typical system for disbursing tangible items of an estate where family members take turns choosing items. With over 700 items, this process could take a long time. And, based on their research, they felt that system wouldn’t maximize the value received by the four children and seven grandchildren.

The Family’s Five-Step Process

Instead, their process for dividing up the intangible items followed five steps:

  1. Sue and Bruce circulated the inventory to all four siblings and asked each to indicate which items they were interested in. This resulted in dividing the items into three groups: (a) those in which no one had any interest; (b) those in which only one person had an interest and (c) those in which two or more were interested. The ones where no one had an interest were set aside to be sold or given away. Those who were fortunate to be the only siblings wanting certain items got them.
  2. Then, Sue and Bruce prepared several lists of items in which more than one sibling expressed an interest. Each received a list of those. They were not given information on items in which they weren’t interested; this was one of two ways the system was not transparent.
  3. Each sibling was then provided with 500 virtual poker chips which he or she could use to bid for contested items. However, before the deadline for bidding, the siblings could talk with one another about their intentions. It turned out that many had bid for several similar items — such as family pictures, bookcases and oriental rugs — when they really only wanted one from each category. So, they agreed among themselves who would receive each one without wasting a lot of chips. Such consultation also avoided two people bidding a lot of tokens for a particular item and no one bidding on another similar one.
  4. After the bids were in, Sue and Bruce let everyone know what they had won, without revealing the bids. So, this was not like a silent auction or eBay where bidders can see what others are bidding and readjust their bids up to the deadline. This was the second aspect of the system that was not transparent.
  5. Finally, once all the allocations were determined, Sue and Brian added up the monetary value of all the items and readjusted the estate monetary distributions to ensure that everyone came out at the same place financially. The most valuable items were a 1919 Steinway drawing room grand piano valued at $25,000; a 2005 Toyota Camry valued at $4,500 and several oriental rugs together valued at $13,975. The recipients of these, in effect, had to pay their siblings something for them, with a total of $17,500 trading hands.

This was a time-consuming process, taking about three months. “It’s a good thing I’m retired,” Sue said, “and that I have a tolerance for detail and my siblings’ trust, which has turned out at certain moments to be very important.”

How did it work out?

The siblings felt their system was very fair and the process, unlike what I’ve seen in some other family estates, not only relieved tensions, it brought Mary Jane’s sons and daughters closer together. The adult heirs were also brought closer by spending time together packing items and getting Oma’s condo ready for sale.

Said Martha: “Our parents always encouraged us to treat each other well and not be horrible.”

By Harry S. Margolis

Harry S. Margolis practices estate, special needs and elder law planning in Boston, answers consumer estate planning questions at the AskHarry.info site and is author of Get Your Ducks in a Row: The Baby Boomers Guide to Estate Planning

Despite recent setbacks in clinical drug trials, other studies show promise


The fight against Alzheimer’s disease remains one of medical science’s more demanding challenges. Progress has been slow and often frustrating, as one drug after another has failed to live up to its promise in human clinical trials.

But those failures, along with technological advances in brain-scanning, have helped stimulate new avenues of research — including renewed focus on development of an Alzheimer’s vaccine.

“There are more new tools for early detection and diagnosis that we haven’t had before,” said Rebecca Edelmayer, director of scientific engagement for the Alzheimer’s Association. “Fifteen years ago, we didn’t even have the capability to look into the brain. Now, this is enabling us to better understand the disease process.”

That has been one of biggest hurdles for Alzheimer’s researchers. It’s still not clear how the disease progresses or if its progression can be diagnosed before it has inflicted too much damage to a person’s brain. It’s still unknown whether one of the key hallmarks of Alzheimer’s disease, the buildup of beta amyloid plaque deposits, is a cause or an effect.

Meanwhile, the toll grows more devastating, with close to 5.8 million Americans living with the disease, and the number expected to rise to 14 million in the U.S. by 2050. In addition, the Alzheimer’s Association estimates that 16 million Americans are providing unpaid care to family members or friends with the disease.

More Funding for Different Approaches

Yet, Edelmayer is encouraged that increased funding from the federal government for Alzheimer’s research has led scientists to broaden their focus in multiple new directions, such as looking for ways to stimulate the body’s immune system to stop Alzheimer’s from advancing.

Researchers are working on a mechanism that would provoke human antibodies to clear out destructive protein buildups in the brain.

For almost two decades, most Alzheimer’s research and pharmaceutical company investments have targeted the clumps of beta-amyloid plaque that collect between neurons in the brains of Alzheimer’s patients. But that approach has proven expensive and unfruitful.

Many scientists now believe that the cause and development of Alzheimer’s is considerably more complex, so they have shifted to other targets. Some are focusing on treatments designed to clear out one of the other biomarkers of of the disease: tangles of tau protein that spread throughout the brain.

Other researchers are zeroing in on what’s known as “neuroinflammation,” an age-related, chronic condition tied to overactive immune cells in the brain. One firm working in this area is INmune Bio, of La Jolla, Calif. Its researchers believe that a sustained abnormal immune response isn’t a consequence of degenerating brain neurons, but rather a cause of cognitive decline.

R.J. Tesi, the company’s CEO, thinks Alzheimer’s has more to do with chronic inflammation that comes with aging than with amyloid plaque. “We believe all the focus on amyloid was really unfortunate because it consumed the field for twenty years,” he says.

Instead, he contends that the key is to target the brain’s innate immune system and develop a treatment that “reprograms” cells that are overactivated. “Complex diseases require combination therapies,” Tesi says. “We feel that what we’re doing will be in the mix of everybody’s combination therapy for Alzheimer’s.”

He says a clinical trial is under way and he hopes that by later this year, scientists will be able to measure if INmune Bio’s drug can normalize the immune systems of patients.

Developing a Vaccine

Perhaps nothing excites the public more than the prospect of an Alzheimer’s vaccine, and researchers are working on a mechanism that would provoke human antibodies to clear out destructive protein buildups in the brain.

Several research projects have reported progress on this, although they’re largely in the early stages of testing. One of the more advanced is an effort by United Neuroscience, a biotech company in Dublin, Ireland. It’s spearheaded by lead researcher Chang Yi Wang and her daughter, CEO Mei Mei Hu.

Last year, United Neuroscience disclosed positive results in small human clinical trials. Nearly all of the patients responded, without serious side effects, to a vaccine treatment that reduced the accumulation of beta-amyloid plaque.

More recently, a joint study by scientists at Flinders University in Australia and the University of California, Irvine found that a combination vaccine given to mice generated antibodies that targeted both beta-amyloid plaque and tau protein tangles.

“The first challenge is making antibodies that target the right place on the abnormal proteins,” says Flinders researcher Nikolai Petrovsky. “We also were able to get more antibodies into the brains of the animals. You have to have enough of the right antibody or you’re not going to see much of an effect.”

He says testing the vaccine therapy on human patients is at least a year or two away. Petrovsky estimated that, best-case scenario, an Alzheimer’s vaccine for humans could be available in five to 10 years. But the Alzheimer’s Association was more circumspect about making a prediction, saying only that given the complexity of the disease, it “will likely require a complex treatment/prevention solution.”

Still, another study at the University of New Mexico reported that mice given a vaccine developed antibodies that cleared tau protein tangles in their brains. Those mice also performed better on memory tests than animals that didn’t receive the treatment.

Looking Ahead to Human Clinical Trials

But once again, human clinical trials, which often are demanding and expensive, are likely years away.

“What we see in one animal doesn’t necessarily mean we’ll see it happen in people,” acknowledges study author Nicole Maphis. “It’s a tightrope we walk.”

Maphis also points out that since Alzheimer’s progression is not well understood, it can be difficult to select the most appropriate patients for a trial and know at what point it’s most helpful to study their response to treatment.

“With clinical trials, they (the Food and Drug Administration) want to see results in two or three years,” she says, “but development of Alzheimer’s is such a protracted disease. You may see results in five years, but you also want to look at ten to fifteen years.”

It’s a daunting challenge, Maphis says. “When you go from lab bench to bedside, it can feel like leaping over the Grand Canyon.”

Words celebrating romantic connection can create meaningful memories


I can’t help loving you more than is good for me; I shall feel all the happier when I see you again. I am always conscious of my nearness to you; your presence never leaves me.

Have you ever received a love letter like this? Or written one? In these two sentences, German writer Johann Wolfgang von Goethe (1749-1832) quite effectively captured some of the sentiments found in an ideal love letter — happiness, longing, attachment — in a letter to his muse Charlotte von Stein, a woman he never married.

Romantic expressions in a letter such as Goethe’s have been around for hundreds of years. And like Goethe, many have also penned their feelings to love interests who didn’t stand the test of time. No matter how the relationship turns out, love letters are powerful.

You might remember the feeling of slowly opening an envelope to reveal a letter, perhaps expressing sentiments that might have been hard to say in person, tucked within. And years later, long after those letters have been stored away, the memory of those words can still carry great weight.

Recently we posed these questions on Facebook to Next Avenue readers: Have you kept love letters you’ve received over the years? Why or why not? Do you ever go back and read them? What is your most meaningful love letter?

The many responses were, in a word, heartening. We received comments from men and women about love letters from long ago, or more recently received, which hold great significance for them and can still provoke strong emotions.

“I keep them tucked away to remind myself how much my marriage has evolved. How that young love has grown into such an amazing friendship and love story.”

Some wrote about letters from spouses who have died, including Sandra, who says of letters from her husband of 42 years: “I’ve kept mine and read them from time to time. My husband passed 8 ½ years ago, so they are bittersweet memories.”

Sally has many letters starting from the time her now-husband was away at college. And in honor of their upcoming 50th anniversary, she plans to re-read all of those sweet missives. Another reader, La Bella Luna, tells about the valuable lessons she finds in the love letters from her husband: “I keep them tucked away to remind myself how much my marriage has evolved. How that young love has grown into such an amazing friendship and love story.”

Dave recounted his first meeting with his wife and how it came at a time when he was going to be moving out of the building where they met. She wrote a letter to him, which she passed on to one of his roommates, about how she wished they had met sooner and how she wished him well.

“It touched my heart that someone would be so thoughtful and straightforward, not expecting ever to see me again,” Dave wrote, adding that she walked into the room as he was reading her note. The happy ending: they went on a date, were engaged after three months, and wed after six. They have been married for 45 years.

Letters from Former Loves

Apart from letters saved by those who stayed together, many readers have letters which serve as souvenirs, for better or worse, of past relationships.

“I have letters from my first love — who is not my husband,” one wrote. “Will read one day when the time is right.”

Another has a letter that she wrote but never delivered to a man who is no longer a part of her life. She is still considering whether or not she will finally mail that envelope.

Reader Kerry wrote from a different perspective: “I am very sad that I burned all of the love letters from my young husband when he left me stranded with a 3-year-old and pregnant with our son. I had his duffle bag full of love letters from him… I could not bear to read them, but I wish I would have saved them for my daughter.”

Tied in Ribbons and Boxes

Many readers told us of letters tied together (“I’m so sad that my girls won’t have love letters to tie with a ribbon to revisit,” writes Pepper) and of boxes tucked away, filled with letters that may never be read again, but how knowing they’re there is gratifying. (I’ll admit to having a similar box that has been opened a few times over the years.)

It was a box of letters from the 1990s that she found in her basement which prompted Michelle Janning, a professor of sociology at Whitman College in Walla Walla, Wash., to take a deep dive into the meaning of love letters (paper versions and the more contemporary emails and texts) for her book Love Letters: Saving Romance in the Digital Age.

“One day in 2012, I started looking through my box and my husband walked in and asked what I was doing,” she says. “When I told him, he was interested and said, ‘I wonder if we are the last generation of letter writers.’”

Janning set out to research that very topic, surveying people from the ages of “18 to 80ish” to find out the significance of love letters in their lives.

“It became clear to me that the difference between the use of digital vs. paper communication varied by age and gender,” says Janning. “What I was interested in was the curatorial process of what people kept, what they shared and how they stored what I call ‘romantic communication.’”

A Letter Held in Your Hand

Love letters can be written on elegant paper or on a scrap from a school notebook; it doesn’t matter to some, as long as the tactile nature of the communication can be felt. As Janning says, the meaning of why a “real” love letter matters might have deeper meaning.

“If you prefer paper, what do you really prefer? Is it something that feels more personal? And is it something you can more easily protect, in a box, than a digital message stored in a mysterious virtual closet that Silicon Valley can access?” she says with a laugh. “A tangible letter can be stored ,and for some, that feels sacred.”

Before you assume that millennials are fine with keeping their romantic communications in that virtual closet, Janning will tell you otherwise.

“In my research, I was surprised to find that young people do cherish handwritten letters. They consider them to be precious, rare and valuable,” she says. “In a sense, they have nostalgia for something they’ve never experienced.”

Janning also found that women were more likely to talk about saving love letters in a special box (a box they were more prone to hide, by the way) while men tend to save fewer letters, but are more likely to keep them in an easily accessible place and look at them more often.

She also discovered that people were equally as likely to keep love letters as they were to destroy them. For some, the highly charged nature of the content provoked them to get rid of letters to prevent unexpected discovery by their children one day. (Sometimes destruction can lead to regret. One Next Avenue reader reported she had kept a batch of love letters for 35 years, and then finally gotten rid of them, adding: “Alas.”)

Janning says that love letters provide a window to the past, and if reflected upon, can reveal how life has changed and how the recipient of the letter has grown.

“Some people look at letters as a reminder of what not to be, while others see their true selves in the words of those letters,” she says.

More Love Letters

If it’s been a while since you’ve written a love letter, the More Love Letters website might have the opportunity you are looking for. Its letters are intended to lift up those who may be going through a challenging time by offering caring words of support and love from strangers.

In 2011, Hannah Brencher, author of Come Matter Here and If You Find This Letter, founded More Love Letters and since that time, more than 250,000 love letters have been sent, in all 50 states, and to more than 70 countries worldwide.

“The topic unlocks something in people – they do beautiful things with these letters, and they can really help change someone’s life.”

Each month, Brencher, who lives in Atlanta, and her team field letter requests from people who are hoping that words of love and encouragement from others will help their own loved ones.

“We’ve had requests for letters for children as young as 12, going through chemotherapy, to a recent request for a 58-year old woman, living with MS, who is experiencing loneliness in the assisted living facility where she now lives,” says Brencher.

The month’s stories, always fewer than ten, are posted on the site. Writers can select a person to write to; letters for each “bundle,” as they are called, are then sent directly to the nominating family member or friend. These bundles are far from small; many contain more than 400 letters. There is no charge to receive letters, and to send one is merely the price of a stamp.

“Then there can be a moment between these two people where they can read these words of love together,” says Brencher, adding that many capture the experience and send photos to the More Love Letters team. “They read them together and cry. Sometimes, they go through them in one sitting, other times they parse them out over time.”

Brencher, who wrote all the letters when her company started, says that it’s surprisingly easy to write letters to strangers. “The topic unlocks something in people — they do beautiful things with these letters, and they can really help change someone’s life.”

Not only are the recipients of all ages, but so are the letter writers. “We have many older adults who sign up to write letters, and many millennials who are fascinated by the idea,” she says. Additional information about participating in More Love Letters can be found on the website.

‘An Indescribable Pleasure’

At their core, love letters can be conversations from the past, and sometimes conversations that last for years. Their meaning is specific and intimate to both the writer and recipient, serving as a reminder of what was, and what is.

For instance, John Adams, the second President of the United States, and his wife Abigail Smith Adams were ardent letter writers. Beginning in 1762, when they first began courting, through the end of John Adams’ presidency in 1801, they exchanged more than 1,000 letters.

As Abigail wrote in their later years, “I look back to the early days of our acquaintance and friendship as to the days of love and innocence, and, with an indescribable pleasure.”

Why some patients prefer a method that extends beyond traditional therapies


But, consider an integrative cancer approach in which patients feel more empowered by an assortment of options they can choose, such as changing their diet, exercise, incorporating methods for reducing stress, seeing an acupuncturist and engaging in mind-body practices. Proponents of an integrative approach say these complements to conventional treatment (chemotherapy, radiation, surgery) make treatment more effective while reducing side effects.

Many cancer patients, like Jasmine Guha-Castle, are turning to integrative cancer care to enhance quality of life, improve outcomes and possibly beat the odds.

Being Positive with a Triple Negative Diagnosis

Guha-Castle, 50, of Austin, Texas, won’t slow down for a minute in her fight to beat breast cancer, again. She made healthy living and volunteering at animal shelters her life’s mission since she overcame breast cancer 13 years ago.

But she received the unfortunate news that her breast cancer had returned while heading to England two summers ago. This time, it was metastatic, meaning the kind that spreads. And it was triple negative, a more aggressive kind of cancer that will not respond to hormonal therapy medicines. So, she flew right back to Austin.

“This place gives me hope, which the other places haven’t so far.”

Early in her treatment, regardless of a chemotherapy day, Guha-Castle could be found swimming in Austin’s Barton Springs pool, attending a meditation class, visiting a nutritional oncologist or acupuncturist, making carb-free foods, dancing and most often, reading science-based information about triple-negative breast cancer (TNBC).

Where you wouldn’t find Guha-Castle was hanging out with other patients just because they share her condition. That “isn’t my cup of tea,” says the expat Brit, who finds it hard to connect with members of the cancer community if they are depressed and not optimistic like she is.

“You have to be positive and proactive to change the environment of your cells,” notes Guha-Castle.

There are more options if you have the right doctor, she says. Initially, she was only treated with chemotherapy and radiation by oncologists who use conventional treatment methods. She says traditional oncologists did not show an interest in hearing about her anti-cancer literature related to medicinal mushrooms, turmeric pills and other approaches that might improve outcomes and help her feel better. She also wanted more guidance, more personalized care and more hope.

Merging Conventional and Complementary Approaches

Integrative oncology is not alternative medicine, which usually refers to treatments used instead of traditional ones. It also isn’t only complementary, which refers to the use of single-intervention add-ons to support mainstream treatment. So, what exactly is integrative oncology?

Here is a comprehensive definition from JNCI (Journal of the National Cancer Institute) Monographs: “Integrative oncology is “a patient-centered, evidence-informed field of cancer care that utilizes mind and body practices, natural products and/or lifestyle modifications alongside conventional cancer treatments. Integrative oncology aims to optimize health, quality of life and clinical outcomes across the cancer care continuum, and to empower people to prevent cancer and become active participants before, during and beyond cancer treatment.”

After reading about cancer programs at different clinics, Guha-Castle decided to fly to the independent Block Center for Integrative Cancer Treatment in Skokie, Ill. She was reinvigorated by the clinic, with all of its physicians and specialists in the same building.

A growing number of leading U.S. cancer care centers claim to have integrative medicine programs.

Guha-Castle found it to be like no clinic she had seen, with a kitchen for nutrition classes, a yoga and exercise area and soothing lighting and music. Exercise equipment was only steps away from the chemotherapy areas.

“This place gives me hope, which the other places haven’t so far,” she says.

She was particularly motivated after reading the Block Center’s preliminary study of stage IV breast cancer patients who were treated there. The treatment improved survival time for the patients, generally, compared to patients treated at conventional clinics.

Dr. Keith Block is the Block Center’s medical and scientific director, and considered to be the “father” of integrative oncology. He developed a treatment program called “Life Over Cancer,” which uses a plant-based diet, exercise, nutritional supplements, nutritional infusions (administered intravenously) and mind-body therapies. He also uses innovative methods of chemotherapy and experimental and off-label medications.

No two patients are treated in the same way there. Treatment is based on individualized testing to determine a person’s “biochemical environment” or “internal biochemistry.” This is the environment surrounding a person’s cancer cells that can influence the growth and spread of cancers. It includes levels of inflammation, oxidation and the state of his or her immune system. Block uses blood tests for this assessment, which he calls this “terrain testing” or taking a blood terrain panel.

At the Block Center, all conventional cancer treatments, physician visits, blood draws and visits with counselors are covered by Medicare and most private insurance plans. Some extras, like dietitians, nutritional supplements and nutritional infusions are out-of-pocket.

Fortunately for Guha-Castle, she can afford to fly to the Block Center every two weeks for treatment. But many people “don’t have the means to do that,” she acknowledges. She is still associated with an oncologist in Austin for blood transfusions and scans, but she says she would rather pay more to get the kind of care she wants at the Block Center.

Integrative Programs at Academic Hospitals

A growing number of leading U.S. cancer care centers claim to have integrative medicine programs.

Dr. Lorenzo Cohen, professor and director of the Integrative Medicine Center at the University of Texas MD Anderson Cancer Center in Houston, says what distinguishes his clinic from the Block Center is being part of an academic medical system. He says blood testing and prescribing medications, particularly of herbs and supplements, becomes a little more challenging when you are in an academic medical center and must follow strict evidence-based guidelines, such as the National Comprehensive Cancer Network guidelines.

Treatments provided by integrative programs within large cancer centers are led by physicians, who also work with providers to guide patients in services like acupuncture, massage, music therapy, yoga, Tai chi and qi gong (methods of movement, breathing and meditation), physical therapy, nutrition and health psychology throughout treatment and whenever possible.

Like other treatment programs, they take commercial insurance and Medicare for standard procedures. The Centers for Medicare and Medicaid Services now covers acupuncture for Medicare patients with back pain. Cohen says this shows that insurers see that integrative approaches are not only cost effective, but a huge value gained in quality of life.

Patient Outcomes and Quality of Life

Dr. Dawn Mussallem specializes in breast care at Mayo Clinic’s Integrative Medicine and Health program in Jacksonville, Fla. She worked with Cohen on an expert integrative oncology panel that recently endorsed the Society for Integrative Oncology Breast Cancer Guidelines.

In the last couple of years, Mussallem developed and piloted a breast-specific integrative medical program within Mayo’s Jacoby Center for Breast Health that included acupuncture, massage therapy, cancer nutrition, mindfulness classes, yoga and superfood cooking classes.

Mussallem met with patients about whole-person well-being, discussing aspects like nutrition, exercise, purposeful living and avoidance of toxins like alcohol and tobacco. The program’s results showed a favorable patient benefit on quality of life, and these integrative services are now offered to all cancer patients at Mayo Clinic in Jacksonville.

“Given the high prevalence of patients using alternative modalities often driven by misinformation available to patients, there is a strong need to guide the use of appropriate integrative oncology care to achieve optimal outcomes for our patients,” Mussallem says.

What happened when this woman let her bank manage her money


Looking for investment advice in midlife can be tricky, so many of us turn to experts for help. But sometimes, those “experts” can be more harmful than helpful. Sadly, I speak from experience.

I thought smooth-talking salesmen would never scam me. After all, I’m a savvy New Yorker with a successful communications business. But I got taken in by a so-called financial adviser at my bank, a large institution where I’d been a customer for decades.

Since I’d kept money there for so long, my guard was down when a representative suggested I talk to a “Relationship Manager” and arrange to work with one of the bank’s financial advisers.

Promises Made, Papers Signed

Papers signed, the adviser pressured me to let him manage my account. He promised smart trades — for a retainer fee plus commissions. The adviser said he could maximize opportunities and I would see impressive results.

It took nearly a year to extricate myself from my “gotcha bank.”

While past performance is never a reliable predictor of the future, I noticed that he didn’t claim a track record for his recommended investments or offer references. I resisted.

But the two of us discussed two companies I was interested in. I agreed to small trades. Or at least I thought I did. Actually, the adviser wound up buying similar sounding, but totally different, companies. When I noticed the discrepancy, he said nothing could be done. I had to go up the chain of command at the bank and spend hours getting those trades reversed.

I wasn’t happy working with this adviser, so I switched to another. And then another. Finally, I’d had enough.

It took nearly a year to extricate myself from my “gotcha bank.” That’s because the papers I’d signed are designed to make exiting complicated and the few moves I’d made had strings attached.

I ultimately wound up sending innumerable emails, made many phone calls and mailed multiple letters to the CEO, the bank’s board of directors and its legal department before I was free.

The 3 Key Lessons I Learned

Now, sadder but wiser, here are some lessons I learned:

Lesson No. 1: Don’t be impressed by titles.

Anyone can call himself or herself a financial adviser. And some who do at banks or brokerage firms are glorified salespeople, often with little training or the appropriate background.

There are, however, Certified Financial Planners (CFPs) who must study and pass tough tests to get this accreditation. And financial advisers known as fiduciaries must put their clients’ interests first. But some who call themselves advisers aren’t fiduciaries.

What’s more, even if someone has credentials, that doesn’t mean that pro is reputable. And a brand name — even the name of a big bank — is no guarantee of competence.

It’s essential to research the complaint record of a financial adviser before hiring one.

The key, says Don Blandin, president and CEO of the nonprofit Investor Protection Trust (TPT), is “finding accredited financial counselors who aren’t selling anything.”

Lesson No. 2: Read the small print.

An adviser at a financial institution may push a proprietary investment — such as one of its CDs — without explaining that you may not be able to easily transfer or sell some or all of it. Or you may be touted a mutual fund from the bank or brokerage with commissions said to be low compared to industry standards. It’s up to you to find out the truth.

I was sold a mutual fund from the bank that the adviser said charged fees that were standard. But when I began the move to another institution, I discovered it wasn’t true — the fees were excessive and, I ultimately learned, I’d pay a penalty for leaving the fund early. I’m waiting for the end of February 2020 in order to get out of the fund, penalty-free.

A few financial institutions, such as Charles Schwab, Fidelity and TD Ameritrade have recently eliminated commissions on some of their online trades. Contrast that with the hundreds of dollars you’d pay at other banks and brokerages.

Many people don’t think to ask what it will cost to buy or sell investments their financial advisers recommend. Be sure you do, and take the time to read, and understand, the fees you’ll be charged.

Lesson No. 3: Educate yourself about investing and advisers before hiring someone to manage your money.

“It’s your money, and you have to do your due diligence,” Blandin said.

There are numerous independent, noncommercial, resources that can help. Their websites are only a click away. Check out the ones from the National Association of State Securities Administrators (NASAA); the federal Securities and Exchange Commission (where you can find “Top Tips for Selecting an Investment Professional;” “How Fees and Expenses Affect Your Investment Portfolio” and “Check Out Brokers and Investment Advisers”) and the financial services industry’s self-regulatory body, FINRA.

Also, the independent Paladin Registry site has many tools for investors, including a free guide on how to interview potential advisers.

The Investor Protection Trust is dedicated to educating investors to be “wise and safe.” It has produced educational booklets, run workshops and created a well-received series of investment education videos for public television.

John Bogle, the late founder of Vanguard, one of the world’s largest investment companies, famously said that investors shouldn’t try to outsmart the market. He advised buying low-cost index funds that replicate the market. But investors should be knowledgeable enough to understand what a financial adviser is talking about, the different types of investments and the fees charged for them.

My Friends’ Experiences

In sharing my story with friends, I was surprised — and saddened — to find that several had similar experiences. I’m sure there are qualified men and women who can help people in midlife better manage their money and plan for retirement. But finding them means taking responsibility and making the effort to do the necessary research.

We need to take our money seriously, and make financial education part of our lives.

What you can try to do for your mom and dad


Often, adult children need some money from their parents. But what do you do when your parents need financial help?

You won’t be alone. According to a 2019 study by the Transamerica Center for Retirement Studies, 8% of Gen Xers and 3% of boomers say supporting their parents is a current financial priority.

If it’s a financial priority for you, take a respectful approach to find out the extent of your parents’ money woes and what you might be able to do to help.

“You don’t want to make it look like you’re criticizing or judging them for making financial mistakes or bad financial decisions,” Huddleston says.

Your mother and father may not have set aside money for long-term care, they may have debts and they may not have built up savings, says Cameron Huddleston, author of Mom and Dad, We Need to Talk: How to Have Essential Conversations With Your Parents About Their Finances.

Think About Your Finances, Too

But before you step in, think about your own money situation. “You have to remember your own finances take priority,” Huddleston says.

You can wind up jeopardizing your own finances by stepping in and doing more than you can afford, she notes. “If you can afford to help them, you have to establish boundaries,” Huddleston says.

If you have siblings, they need to be part of this conversation. “You need to be talking to them,” Huddleston says. “Share the responsibility. Figure out what each of you is willing and able to do.”

Once you determine how much you can afford to help financially, reach out to your parents — gently.

“You don’t want to make it look like you’re criticizing or judging them for making financial mistakes or bad financial decisions,” Huddleston says. “Instead, you might want to ask an open-ended question: ‘Mom and Dad, what does retirement look like?’”

Spotting Signs of Financial Difficulty

Nola Kulig, 61, of Longmeadow, Mass., says that after her father died, and her mother progressed through her 80s, Kulig began watching for signs of financial difficulty.

“She said something to me about the nice people at the IRS who had fixed her return. That set some alarms off,” Kulig remembers. So Kulig offered to help her mom manage her finances.

She became a joint owner on her mom’s checking account, making it easy to see how her mother was doing paying bills. “So, I began watching for any signs of issues there,” Kulig says.

Also, a friend of Kulig’s had stopped in to check on her mother and found she was in danger of having her utilities cut off due to nonpayment. “We fixed that and put her on an autopay program,” Kulig says.

“With hindsight, I wish I had stepped in sooner,” she says.

Start the Conversation Early

Her advice to others: “Start the conversation early. This is easier in some families than others. But if family has always played a role in helping each other, it comes naturally as life progresses,” Kulig says.

You might want to refer your parents to a financial planner or to a credit counselor with free budgeting advice or to free budget apps. “Point them to resources that can help them,” Huddleston says.

Since housing is such a big expense, it may be time for your parents to downsize to a more affordable home. If so, here is the big question:  “Is there space for them to move in with you?”

Otherwise, if they are open to the idea, you can go through your parents’ expenses to see what they can cut. “Help them find ways to improve their financial situation,” Huddleston says.

Don’t forget to check out federal, state and local resources that may help. Visit the federal government’s Benefits.gov site to find out which benefits your parents may be eligible for and how they can receive them. The National Council on Aging also has a useful, free guide to benefits for older Americans: You Gave, Now Save.

The Logistics of Assistance

After you’ve explored all the resources and you’re also ready to help your parents financially, make sure you incorporate any assistance into your financial plan. “It needs to be a line item in your budget,” Huddleston says.

Rather than giving your parents cash or a check to pay outstanding bills, however, pay the bills yourself. That way you’ll be sure the money is actually used for the bill and not for something else.

If your mom or dad needs help with daily living, reach out for help from a volunteer at their church or synagogue.

Helping With Long-Term Care Costs

For long-term care assistance, check out resources. Are your parents eligible for Medicaid? Do they have an elder law attorney? The local Area Agency on Aging can link you to local resources.

Carolyn Rosenblatt, author of The Family Guide to Aging Parents, recommends ensuring your parents understand that you have their best interests in mind when helping with long-term care.

“Be respectful of the parents. They need to have control,” says Rosenblatt. Tell them that you — and your siblings, if that’s the case — aren’t trying to take over. “Honor what the elders want,” Rosenblatt says.

Adds Kulig: “Offer to help first, rather than order. It will be better received.”

‘Legacy List’ shows that moving out is about memories, not money


When you think about downsizing your home and relocating, there’s a word that probably comes to mind: yecch. The process can be time-consuming, agonizing, frustrating and just plain sad. But, as the new public television series Legacy List shows (check local listings), downsizing also has an upside.

“When you start to downsize, it forces you to go through your memory bank,” says Matt Paxton, 43, host of Legacy List and formerly from A&E’s Hoarders. “Everybody’s got a story.” (Although Next Avenue is a website also from public television, we’re doing this story because we know the themes of Legacy List show resonate with our readers.)

In each episode of Legacy List — a cross between Antiques Roadshow and Finding Your Roots — Paxton and his team go through the house of someone 50+ who’s about to downsize and they scour for family memorabilia — often items the owner can’t locate. Some of the possessions to unearth are sentimental; some are historic; some seem to tell stories of descendants. Earthly treasures, all.

What to Do With All That Stuff

“For me, downsizing was partly pushed on me,” Anne Manley told me, talking about her Legacy List episode. She needed to sell her Richmond, Va. home to move near her eightysomething parents in Jacksonville, Fla. “I got a great offer, but the buyers had me move out in seventy-two hours. I got married when I was twenty-three and now I’m almost sixty. So, I had all that stuff.”

“For me, it was a step back, reminding me of the people in my family, historically and in the present — exceptional, special people.”

Manley’s father, Peter Schoeffel, was a POW who shared a cell with the late Sen. John McCain in Vietnam. “He’s one of the oldest living POWs left,” says Manley. Her husband, Jack, who died of pancreatic cancer eight years ago, was a former Air Force commander who graduated from the Virginia Military Institute (VMI). Their son Miles also graduated from VMI; Manley has two grown daughters.

Her Legacy List episode explores the family’s military history through items that had been tucked away. “For me, it was a step back, reminding me of the people in my family, historically and in the present — exceptional, special people,” says Manley. The filmed process of moving out “was more about that, and less about downsizing,” she adds.

Part of Matt Paxton's team on 'The Legacy List,' Jaime Ebanks helps homeowners assess the value of their possessionsCredit: American Public Television
Part of Matt Paxton’s team on ‘Legacy List,’ Jaime Ebanks helps homeowners assess the value of their possessions

What She Didn’t Ask Her Grandmother

I also talked to the downsizer in another episode, Lillian Lambert, the first African-American woman to get a Harvard MBA. Now 79, Lambert and her husband John were relocating from their four-bedroom Mechanicsville, Va. house to a 1,200-square-foot apartment in Richmond., about seven miles away.

Among the items Paxton & Co. turned up: the promissory note showing Lambert had paid off her MBA and an organ from the 1860s that belonged to Lambert’s grandmother. “I didn’t ask my grandmother or my mother about the organ when I was young,” says Lambert. “You don’t have the same interest in learning about things then as you do later in life.”

In another episode, former art historian and world traveler Lenis Northmore has to empty her 6,000-square-foot, 20-room, 19th century, Newark, Del. house (with a giant oil painting hanging on a kitchen wall and hidden rooms reminiscent of the film Knives Out). Northmore is moving to a 2,600-square-foot home in Williamsburg, Va. near her daughter, Angelica. She has to be out in three days, since a new family is ready to move in. “I’m a little nervous,” Northmore says in the show.

The Treasure Trove Hidden in Homes

Paxton’s description of Northmore and her home: “She not only appreciates grandeur in style, she lives it.”

His downsizing brigade finds, among other things: an American flag from the late 1800s; a jade piece from a Chinese emperor; part of a carved prow Northmore’s dad brought back after serving in the South Pacific during WWII; a model railroad car her grandfather made for Northmore’s mom when she was a child and an antique doll collection, found hidden in a chest of drawers. “This has just been a revelation,” says Northmore.

“As a young girl, my grandmother would pull me into the dining room and uncover her dolls. It was almost a sacred ceremony.”

The kitchen painting, it turns out, wasn’t by German-American artist Albert Bierstadt, as Northmore had hoped. If it was, one of Paxton’s associates said, it could be worth $30 million. “This painting,” he notes, “can bring about two thousand to five thousand dollars.” Says Paxton on the show: “Sometimes, big is just big.”

That moment signifies one of the surprising elements of the series. The downsizers aren’t looking to sell their possessions and make a bundle. For them, it’s all about the memories the items bring back and the stories the homeowners and their children can share.

After seeing the dolls, Northmore’s daughter says: “As a young girl, my grandmother would pull me into the dining room and uncover her dolls. It was almost a sacred ceremony.” Finding them again, she says “brings back precious memories.”

Magical Memories for Millennials

Paxton says he came away with much greater respect for millennials after filming the series.

“Guess who shows up to help with the downsizing? The grandson, who’s just out of college. Or the daughter who’s in college,” he notes.

Yes, it’s true, that adult children and grandchildren often don’t want to take items from a downsizing parent or grandparent’s house, due to different tastes and a lack of space. But what they do want is “to spend time with grandma,” learning the history of her belongings and her longings. “It ain’t about the stuff,” says Paxton. (I wrote about this in my viral Next Avenue blog post, “Sorry, Nobody Wants Your Parents’ Stuff.“)

Neil Patel, one of Legacy List’s executive producers, says working on the series has shown him that downsizing is “a bittersweet moment — when the relationship with the  house you and your parents lived in for thirty years  comes to an end.” This moment in life, he adds, is an “inter-generational transition story.”

Downsizing Advice From the Downsizers

I asked Lambert and Manley what advice they’d offer others about downsizing.

“Just start,” laughed Lambert. “If you’re uncertain how to do it, get someone to help you. And you’ll say: ‘Gee, this isn’t so bad after all.”

Manley’s tip: “Don’t be afraid. If you have too much stuff when you get to where you’re going, you can still get rid of it. They’re just things.”

By Richard Eisenberg

Richard Eisenberg is the Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue and Managing Editor for the site. He is the author of How to Avoid a Mid-Life Financial Crisis and has been a personal finance editor at Money, Yahoo, Good Housekeeping, and CBS MoneyWatch. Follow him on Twitter.

The author of a new book took the plunge, and offers advice


You’re probably familiar with the idea of a work sabbatical: a paid leave, usually from one month to a year, often to study or travel. But what about a soulbbatical?

Never heard that word? It’s OK. Shelley Paxton, author of Soulbbatical: A Corporate Rebel’s Guide to Finding Your Best Life, made it up to describe her own experience, jumping off the corporate treadmill to become what she calls the “Chief Soul Officer” of her life. I recently spoke with Paxton about what a soulbbatical is, who can have one and how to do it (highlights below).

For 26 years, Paxton had a glamorous, successful career, working as a marketing and ad exec at companies like Visa, AOL, McDonald’s and, her last stop, Harley-Davidson, where she spent almost three years as vice president for global marketing and brand.

“My father had been a CEO and chairman and president of many companies. I realized I had been following in his footsteps. That was an honor, but I was chasing his dream.”

But while at Harley, Paxton felt a tug. She up and quit at age 46, in 2016, to figure things out. I’ll let her tell you about this and share her advice if you might want to take a soulbbatical, too:

Next Avenue: What is a soulbbatical?

Shelley Paxton: It’s a made-up word; I mashed together soul and sabbatical as I was leaving my job. I wanted people to understand leaving my prestigious role at Harley-Davidson wasn’t a flip decision.

It was a deeper search for self. It was me wanting to have a relationship with my soul and understanding my deepest desires and purpose.

I’ve been on this journey for over three years and have realized that it’s a way of living; it’s not a defined period of time. It’s a way of living a more authentic, more courageous life, on purpose. A soulbbatical is a very unique journey for each human.

Is it about leaving a job?

It’s not about leaving your job; it’s about finding yourself.

Do you need to be wealthy to have a soulbbatical?

I had a little runway, financially. But I was recovering from a financially devastating divorce, so I was in no way financially free or independent or ready for early retirement. But I decided I was willing to invest in the possibility of my future self.

I think anybody of any means can enjoy a soulbbatical.

How did you spend your soulbbatical time?

I spent eight months traveling and doing deep internal work. After eight months, my father suffered a massive stroke at age seventy-one, that came out of the blue. That became part of my soulbbatical. I got a master’s class in life.

I realized it was time to live life on my own terms. I realized, with subsequent conversations with my dad, that it was time for me to shift to the business of living.

My father had been a CEO and chairman and president of many companies. I realized I had been following in his footsteps. That was an honor, but I was chasing his dream. That was a defining moment for me, thinking: ‘What is my dream? What does Shelley Paxton want to accomplish in this world and what impact does she want to have?’

What is the purpose of a soulbbatical? And what was its purpose for you?

The purpose, as I define it, is rebelling for who you are and what you believe and the impact you want to have.

By the traditional definitions of success, I could tick all the boxes: iconic brand; good title; traveling the world on a motorcycle; making good money. By all accounts, I had it all. But there was something that felt unfulfilled inside of me. I would say I felt I was dying a little on the inside. I was feeling it, from burnout and many illnesses.

Did you plan out your soulbbatical before you left Harley?

It wasn’t spur of the moment, but it was probably not the most planned out thing either.

Six months before I left, I realized I had to take this seriously, even though I was terrified at the thought of leaving and walking away from the privilege and good fortune I’d been blessed with. It gave me a lot of guilt and worry and anxiety. Nobody gets to the peak of their career and walks away — or do they?

I spent time with an executive coach and a financial adviser to mine my feeling and understand what I was looking for.

Why not just switch to another job or field? A lot people do that when they want to find more purpose in their lives.

I knew I was being called to do something different, and that I had to spend time to get to know myself and reconnect with my soul. I kind of laughed at myself, asking: ‘How will you explain this to anyone? It sounds very woo-woo.’

But I knew I wasn’t being called to my next job. I was being called to slow down. My coach said: ‘You need to slow down to speed up.’

I knew I had to take a break. I thought it might be a year long, but that I might not last a year. I love to work. I thought I might be back in the corporate world in three to six months.

You believe soulbbaticals can be very different for different people.

I tell several stories in the book about other people taking soulbbaticals.

One woman asked for a soulbbatical from a major tech firm in Silicon Valley. That company had no precedent to take a sabbatical, let alone a soulbbatical. She asked for a hundred days off and it completely changed the trajectory of her professional and her personal life.

Another woman and her husband took their family around the world for twelve months. She didn’t have a massive savings account and they had four children. They did it on a shoestring budget, with backpacks and camping.

How do you think someone should plan for taking a soulbbatical?

Find two weeks to do the hard work and go into a proverbial cave and give yourself enough time and space and quiet to listen to your soul and decide what you really want. What life do you want to create?

If someone takes a soulbbatical and is away from work for some time, won’t it be hard to get hired after that? 

I can only speak from my personal experience. I don’t necessarily get the phone calls three-and-a-half years out that I did before. Now, I run my own business coaching practice and I write books.

You don’t necessarily know where the journey is going to take you. Mine took me to a place of being an entrepreneur and an executive transformational coach and author. That’s something I never could have predicted.

It can work in a zillion different ways.

Should you get an adviser before starting a soulbbatical?

I’m a big advocate of asking for help; that’s one of the codes of a Chief Soul Officer. Be honest about what you want to set aside to invest in the possibility of your future self, and your time horizon.

Is travel important for a soulbbatical? You have what you call ‘chronic wanderlust.’

I thought travel would be the answer, going to fabulously inspirational places that would help me sort this all out. I did spend some time in France and New Zealand and then following breadcrumbs; there was a different lesson in every place.

There is some value in getting out of your day-to-day. But no landscape is as powerful as your soulscape.

Is midlife a good time for a soulbbatical?

I think there’s a beautiful synergy with that second act. There’s a huge opportunity to say: ‘I’m going to do this on my terms.’

And who shouldn’t consider a soulbbatical?

Someone is not a candidate if they’re not willing to do the work. If this is an excuse to do fun travel or to just walk away from a job and not dig deeper, then don’t call it a soulbbatical. It’s much more of an internal journey than an external journey.

You think more employers should allow, and even encourage, soulbbaticals?

Employers may be nervous about losing employees this way, but courageous leaders will take that risk. I’d like them to flip the script.

High turnover due to burnout is costing companies a fortune. They’re losing good people and paying a lot to replace them. But what would it look like if the employers took care of those people in those roles after taking soulbbaticals, rotating them out to free their mind and body? And then put them back in with tools to manage their roles, so they’ll stay there?

That hasn’t happened yet. But I imagine a world where we can have more of these conversations with c-suite executives, so radical self-care is on the agenda.

I wrote the book with the hope and intent that more of us become Chief Soul Officers. Then, by default and by demand, the conversation we need will happen in companies. I call that ‘the soul of business.’

Check your progress in these areas of a brain-healthy lifestyle


A lot of hands went up.

At age 65, your risk of being diagnosed with Alzheimer’s is 2% per year. If you have a parent with Alzheimer’s disease, that risk goes up by 30%, to 2.6% per year, according to the Harvard Men’s Health Watch.

However, that’s still a relatively small increase. A recent Centers for Disease Control and Prevention (CDC) report found 92% of us fear developing a degenerative brain disease like dementia or Alzheimer’s and 28% aren’t sure we can do anything about it.

“Everyone, as they age, faces changes in brain function — just like any other part of the body, our brains age,” says Dr. Marc Agronin, senior vice president of Behavioral Health and chief medical officer for the MIND Institute at Miami Jewish Health and author of the book The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer’s Disease and Other Neurocognitive Disorders.

7 Pillars of a Brain-Healthy Lifestyle

We know living a healthy lifestyle is key to preventing chronic illness and conditions like diabetes and heart disease. But now, research finds that living a brain-healthy lifestyle may reduce your risk for Alzheimer’s disease, dementia and other cognitive decline.

The mind-blowing research on exercise alone should get you moving.

The research on cognitive health and disease has homed in on seven pillars for living a brain-healthy lifestyle, which may in combination, slash your risk for brain-degenerative diseases.

Just keep in mind, however, that even if you performed all these pillars perfectly, it doesn’t mean you won’t get Alzheimer’s disease. Other factors, such as genetics, additional medical conditions that affect the brain and accidents, can’t always be controlled.

Pillar No. 1: Exercise 

The mind-blowing research on exercise alone should get you moving.

A 44-year Swedish study that separated midlife women exercisers into low, moderate and high fitness levels found that women at the lowest fitness level were 45% less likely to develop dementia, while women in the top fitness level were 88% less likely.

It seems exercise reduces chronic inflammation and increases the release of a protein that’s good for brain cells. Plus, it improves your overall health, so you’re reducing cardiovascular dysfunction, your risk for diabetes, high blood pressure and high cholesterol, which are all bad for your brain, explains Dr. Yuko Hara, who leads the Aging and Alzheimer’s Prevention team at the Alzheimer’s Drug Discovery Foundation.

Researchers recommend 30 minutes of moderate exercise — walking, riding a stationary bicycle or whatever you love to do so you’ll stick with it — three to five times per week to gain the benefit.

Pillar No. 2: Diet 

“The only diet that really has robust evidence showing risk reduction for dementia is what’s called the MIND diet,” Agronin says. It is a combination of the Mediterranean diet and what’s called the DASH diet, which is a low salt, healthy diet (MIND stands for Mediterranean-DASH Intervention for Neurodegenerative Delay).

The MIND diet includes loads of fruits and vegetables, fish, legumes, poultry, olive oil and one glass of wine (if you drink alcohol), while reducing processed foods, sugar, whole-fat dairy and red meat.

A healthy diet produces more brain tissue volume, more gray matter, a larger hippocampus (which controls memory) and lessens your risk of developing dementia, according to a study published in 2018 and conducted by researchers at the Erasmus University Medical Center in Rotterdam, Netherlands.

“We may not know all the mechanisms of why a healthy diet is protective for brain health,” Hara says. But the MIND diet is filled with antioxidants and polyphenols from fruits and veggies, anti-inflammatory properties like omega 3 fatty acids from fish, and reduces your risk for Type 2 diabetes, high blood pressure and high cholesterol — all associated with dementia.

Pillar No. 3: Mental Fitness

Learning builds cognitive reserves, which is the capacity of your brain to function optimally despite the changes that occur as we age. Learning also helps the brain resist cognitive decline.

“Research suggests mid- and late-life cognitive activity, especially, is linked to delayed onset of cognitive decline,” Hara says. Lifelong learning is fundamental to improved brain health, higher levels of cognitive activity and staving off Alzheimer’s disease and dementia.

So, sign up. Pick anything that interests you. Learn an instrument, take up a language or join some kind of class. If you’re working, try to learn something new every week on the job. Read, take an online course, teach yourself the Latin names for the plants in your garden or anything else you want to know. Then, keep learning.

“Research suggests mid- and late-life cognitive activity, especially, is linked to delayed onset of cognitive decline.”

Pillar No. 4: Social Interaction

Scientists have found people with few social contacts and who feel lonely or isolated have a 26% increase in dementia and mild cognitive decline. Some studies also suggest lonely people have higher amyloid and tau in the brain, biological telltale markers for Alzheimer’s disease. The connection between loneliness and dementia is still unclear, but it may have to do with depression or lack of stimulation.

If you are geographically apart from family, have lost a spouse or tend to isolate with fewer social contacts as you age, step up your social game. Phone or video-message with faraway family and friends regularly or participate in groups like walking and museumgoers. Establish or maintain strong connections with a neighbor, friend or childhood bestie. Talk, visit and interact with others. Your brain depends on it.

Pillar No. 5: Sleep

Poor sleep is also connected to Alzheimer’s disease and an increase in the presence of amyloid and tau. However, “we don’t really know if poor sleep causes Alzheimer’s disease or Alzheimer’s disease causes poor sleep,” Hara says.

Despite this chicken-or-egg riddle, experts recommend seven to eight hours of sleep a night. Practice good “sleep hygiene,” like avoiding caffeine and alcohol before bed. If you have a sleep disorder such as sleep apnea or insomnia, talk to your doctor and get it treated. Disorders like sleep apnea deprive the brain of oxygen during sleep, which impairs its function over time.

Don’t just resort to taking sleeping pills, since they also have been associated with dementia, Agronin says.

Pillar No. 6: Stress

High levels of stress are linked to memory problems and smaller brain volume. What’s more, the hormone cortisol, produced when you’re stressed out, may damage cells needed for learning and memory, Agronin says.

When you’re under stress, you need to learn ways to cope. Practice whatever works best for you, which could be: yoga, meditation, taking a walk, playing with a pet, listening to music, knitting, reading a novel, tinkering in the garage or anything else you find enjoyable and relaxing.

Pillar No. 7: Overall Medical Health

The illnesses most related to brain health include Type 2 diabetes and hypertension. For example, people with diabetes have a twofold higher risk of developing a type of dementia called vascular dementia, and a 73% increase risk of any dementia, including Alzheimer’s disease, Hara says.

Depression is another risk factor for dementia and Alzheimer’s disease.

Taking care of your overall medical and mental health plays a critical role in living a brain-healthy lifestyle. You should see your doctor regularly, get annual screenings and manage any chronic illnesses you have.

Agronin also recommends keeping a positive attitude toward aging and fostering a strong sense of purpose. Volunteering, focusing on relationships and having an interest in civic, religious or spiritual associations can have a powerful impact on living a brain-healthy lifestyle.