Adults over the age of 18 y.o. (in most states) have the right to manage their health affairs. An important step is to complete the necessary documents in case you become incapacitated – a situation where you are unable to make medical decisions. Keep in mind that you are not relinquishing your ability to decide when you have full capacity.
    
When we assign someone to make our wishes known that person is called the healthcare agent and we fill out the health proxy form. Although it is considered a “legal” document, this form does not require a lawyer’s involvement and it does not need to be notarized. It requires the witnessing of two signatures. But that is the simple part; it tells the world “the who” you assigned to take your place. The critical completion of advance care planning is “the what” – having a conversation with your healthcare agent in order to describe your healthcare decisions in detail. “The Conversation” by Angelo E. Volandes, MD. is a helpful guide, since talking to others is often challenging when the subject is “the unspoken” – the decisions about end-of-life care.
    
In addition to completing the health proxy form and having the conversation, other helpful forms include a living will and/or MOLST/POLST form. These forms list specifics as to what treatments you want done or do not want done. By putting this information in writing and signing it, there is more weight and clarity placed on your decisions. MOLST stands for Medical Orders for Life-Sustaining Treatment. A POLST form is the same document; the “P” stands for “Physician.” With MOLST/POLST, you review your decisions with your provider (doctor, nurse practitioner, or physician assistant depending on the state) and in addition to you signing the form, the provider signs the form. By completing this form, it officially makes your decisions medical orders, and those orders are to be followed when/if the time comes. If you are interested in more details about the use of these forms, more information about advance care planning and ordering these forms (they are free), visit the following link: https://compassionandsupport.org/.
    
The next step is to distribute these forms. They don’t do any good if they remain in your file cabinet. You must give a copy to your healthcare agent, so they can reference your decisions and prove that they are the healthcare agent. You also want to make sure your key providers have a copy of this form, so that includes your primary physician and perhaps any specialists. Some people with severe chronic conditions give a copy to their local ER.
    
Overall, the above advance care planning steps seem pretty simple. Yet, I have served in assisting many families in my career and people are often not prepared for end-of-life decisions. One family member never told her niece, who lived out-of-state, that she was the healthcare agent. The niece had no form and never had a conversation about her aunt’s wishes. Yet when the aunt was dying and unresponsive, the niece had to make the decisions. It is not unusual that healthcare agents have the health proxy form but have failed to obtain a copy of the living will or MOLST form, so they have nothing to reference and are not sure what to do. There are people who have all the forms, but never had the conversation.
     
Even for those who are prepared, people struggle when the time comes to take action. Do you think you will be ready to manage end-of-life decisions? All too often I have witnessed healthcare agents backing off and changing the outcome of what their loved one’s expressed. So, I will pause here; this is where you want to think long and hard about who you trust to be your healthcare agent. It’s a possibility that the one you love the most may not serve you well in this position. We see this happen in our ICUs throughout the country: aggressive interventions taking place when the person did not want this. Then the question becomes: “Who are We Caring for in the I.C.U.?” This is the title of an opinion piece – described as follows.
     
With the pandemic we are reaching the one-million mark for the number of deaths following end-stage COVID. Here is what it looks like: Your loved ones are intubated, in total respiratory failure, unable to ever breathe again on their own; they are unresponsive and nothing more can be done, except to deeply sedate them in hopes that they are not suffering in pain. But  all too often what happens, instead of allowing the person to die, is that family members are not ready to let go. Despite death being inevitable in these cases and even if aggressive treatment is not what the individuals wished for in their advance care planning, we see family members following their own needs and desires. What happened to respecting the wishes of their loved ones?” As the author states in this article: “There is a largely unacknowledged moment in critical care when doctors and nurses shift from caring for the patients in front of us to caring for their loved ones” (https://www.nytimes.com/2022/02/06/opinion/intensive-care-patient-hospital.html?campaign_id=2&emc=edit_th_20220207&instance_id=52367&nl=todaysheadlines&regi_id=38880717&segment_id=81884&user_id=84c20c0fc176cb81ea3bb1ada54911fe).
     
Taking on the role as a healthcare agent requires contemplation. We need to be realistic about our abilities and determine if we are prepared to take on the task. The one serving this role must have compassion for the person dying, while overriding their own grief. There is nothing easy about that.
     
Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

In just a month’s time from my last column; the situation has gotten worse. The number of people with COVID in the U.S. has skyrocketed. In one January day America had 1.35 million patients with COVID (more than any other nation during all of the pandemic). Out of those millions of people with COVID, the hospitals have seen an 83% increase in hospitalizations.
  
The situation has gotten so extreme with the unvaccinated population that even some of the top scientists are giving up. People assume that these scientists now think COVID does not require the strict guidelines as we originally thought; this is not accurate. It means we are at a point where, sadly, these scientists are surrendering to the fact that people will have to die or get very sick. Is that really the choice we want to make when we have other options that work?
  
If this is the path we choose as a nation – let people die and get sick, instead of wearing a mask and getting vaccinated, we still have other consequences to face. Due to the trauma of two years of COVID and the added disregard for hospital staff, we have pushed droves of healthcare workers out of the hospitals. If we continue to shun our healthcare system by refusing to follow guidelines and then expect our healthcare workers to take care of us (the numbers are massive) when we get COVID, the system will collapse. Why?

1. Hospitals are working in crisis mode; you cannot keep up this pace forever
2. When there are shortages to this degree, there are compromises with the delivery of care
3. Too many patients results in no bed availability; patients wait for hours to get care; or they are shipped out to other hospitals, while others get sent back home with their illness, need for surgery and pain
4. When you call for an ambulance, expect to wait
5. If you think health care costs are high now, this is “little league stuff”

What is the solution to prevent the healthcare collapse and once again provide vacancies at our hospitals? Get vaccinated, wear a mask and encourage and educate others to do so.

1. Simply put, the vaccine is safe. Look around and take note of the hundreds of millions of people vaccinated. Not only are they not dead, they are functioning quite well. For example, Donald Trump says that he is doing just fine being vaccinated and boostered.
2. Do you know someone afraid or anxious? Encourage them to talk to a healthcare professional about their fears; the fears are not based on reality. What is real is that we are facing the denial of medical care because of the lack of bed availability and there is not enough staff to care for us.
3. Do you know people who are stuck… a product of inertia? Help get them motivated with information – such as what is presented here.
4. Do you know of people being misguided? Public health measures have been in place for years; this is nothing new. This particular vaccine for COVID has been researched for years and wearing a mask is a simple preventative measure (our surgeons and operating room staff do it all the time). We want safe water to drink; we want uncontaminated food; and we do not want toxins in our medicine. Public health measures keep us safe.

Not wearing a mask and not getting vaccinated because of one’s feelings, denial or selfishness will backfire on us. We are in a pandemic and not recognizing what needs to be done to fix it can really result in our health being compromised. The virus has no emotions; it only knows survival and how to march on.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

Like any living creature, viruses want to survive. So despite what we – as humans – feel, believe or think, the virus continues to mutate, adapt and live on. Hospitalizations due to COVID infections are rising in 42 states; hospitals are once again overwhelmed, and there has been a mass exit of healthcare providers leaving hospitals, due to the burdens of caring for COVID patients and the risks they impose. Patients with ruptured appendixes, broken bones, heart conditions, cancer and more are waiting for hours in emergency departments – often only to be transferred elsewhere because there are no beds. Elective surgeries for countless others are being postponed, and patients are dangerously delaying their surgeries. Our hospitals are very sick, the health care workers are living in constant crisis, and our society is not paying attention (Medscape, Dec. 2021). What happened to calling them “our heroes” as we did at the beginning of the pandemic?
     
We still have people refusing vaccinations and others not enforcing the wearing of masks indoors when we are in public places where the vaccination status is unknown. These two measures prevent the spread of infection, protect others, improve our quality of life including economics, and they are simple to do. We know what measures control the spread of variants – masks, better ventilation, testing, contact tracing, quarantine, and restrictions on gathering, but the U.S. has failed to invest in these tools and approaches. We will feel the pain, just like our hospitals are feeling it now.
  
As of December 13, 2021, Medscape (and other sources – see below) report the following statistics:

• 1 out of 100 seniors in our country has died from COVID
• Indiana, Maine, and New York have requested aid from the National Guard,
• The Great Lakes region and the Northeast are seeing some of the most severe increases
• COVID cases are expected to double throughout December in NYC, Philly, Boston, and Baltimore
• Most of the U.S. will see significant growth in COVID-19 cases during the next four weeks, according to PolicyLab at Children's Hospital of Philadelphia.
• Michigan has the country's highest hospitalization rate, and federal medical teams have been sent to the state to help with the surge in patients. The surge is described by healthcare professionals as "critical" and "deeply concerning.” They requested 200 more ventilators from the Strategic National Stockpile.
• Americans are still dying of COVID every day, and more have died this year than last.
• According to the virologist John Lowe: “The University of Nebraska Medical Center in Omaha, which entered the pandemic as arguably ‘the best prepared hospital in the country’ recently went from 70 COVID patients to 110 in four days, leaving its staff grasping for resolve.”
• People who are getting milder cases and are unlikely to be hospitalized can still spread the virus to those who are more vulnerable. And yes the case might be mild, but what about the long-term COVID effects? What will this do to society? “The collective threat is substantially greater than the individual one” (The Atlantic 12/16/21).
• Two years of trauma have pushed droves of healthcare workers, including many of the most experienced and committed, to quit their jobs. The remaining staff is ever more exhausted and demoralized, and “exceptionally high numbers” cannot work because they got breakthrough infections and had to be separated from vulnerable patients.
• Vaccines are not the only solution to decreasing the spreading of the virus. What are the other strategies to help end the pandemic?

    o better masks
    o improved ventilation
    o rapid tests
    o places where sick people can easily isolate
    o paid sick leave and other policies that protect essential workers
    o social distancing
    o a stronger public-health system
    o retaining the frayed healthcare workforce

Instead of trying to beat the coronavirus one booster at a time, the country needs to do what it has always needed to do—build systems and enact policies that protect the health of entire communities (The Atlantic 12/16/21).
     
The future behavior of the virus is unknown. We could experience endemics – with the holding of the virus in a tenuous stalemate. But there are other unknowns: If two variants or more end up co-circulating, then what we are seeing now is little league action compared to the major league action of what can happen with multiple variants at the same time. Like the previous variants, Omicron requires individuals to think and act for the collective good, and we have failed at this. We are witnessing defiance (like two-year olds having their temper tantrums) with too many people acting irrationally and stubbornly. We know the measures that work and even our public leaders are in denial. Yet our doctors and nurses are begging us to listen because they have the knowledge. We might want to believe that it will only impact the healthcare workers (and that in itself is a disgrace that many don’t care), but this crisis will trickle down to all of us. “Self-interest is self-defeating, and as long as its hosts ignore that lesson, the virus will keep teaching it.” (The Atlantic 12/16/21).

Sources

1. https://www.theatlantic.com/health/archive/2021/12/america-omicron-variant-surge-booster/621027/?utm_source=newsletter&utm_medium=email&utm_campaign=atlantic-daily-newsletter&utm_content=20211216&utm_term=The%20Atlantic%20Daily
2. https://www.nytimes.com/2021/12/08/opinion/covid-michigan-surge.html?campaign_id=2&emc=edit_th_20211209&instance_id=47210&nl=todaysheadlines&regi_id=38880717&segment_id=76501&user_id=84c20c0fc176cb81ea3bb1ada54911fe
   
3. Medscape December 2021

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

Emotion is described as a reaction to a person, object, or situation in our life; it can be real or a thought. Our emotional responses are often connected to past experiences and are distinguished from reason or knowledge. Spirituality addresses the “big picture” – a search for meaning in our lives. Spirituality has many definitions, and a secular vs. religious distinction helps to clarify the meaning (Soul Matters: The Spiritual Dimension Within Healthcare by Dr. Mabel Aghadiuno). Secular spirituality is not necessarily connected to a specific belief system or even religious worship. Instead, it arises from our connection with ourselves and with others, the development of our personal value system, and our search for meaning in life. For many, spirituality takes on the more traditional form of religious observance, which includes a certain dogma, belief system and recognition of a higher power.
    
When it comes to sorting out the elements of “mind, body, spirit,” the whole point is that they are interconnected. Using this approach to healthcare is called holistic health. The mind-body connection is a well-known concept in medicine, but the spirit part is often cast aside. As health professionals, we assess physical and mental problems, but spiritual assessments are often dismissed as too time-consuming, not useful, irrelevant, or simply a check-box on the assessment form listing your religious practices (http://www.aafp.org/afp/2012/0915/p546.html).
    
Practitioners are typically not adequately trained in the area of spiritual assessment, or they do not believe it has a place in the biomedical world of clinical practice. Yet studies demonstrate that most patients want their spiritual needs assessed and addressed and that patients feel their spirituality does result in improvement in their well-being (https://link.springer.com/article/10.1007/BF02248742).
    
There are various spiritual assessment tools, but the groundwork begins with a patient simply wanting a trusting relationship with his/her doctor. Patients want their doctors to talk to them and to show some understanding. One could conclude that a doctor has the “power” to relieve suffering just by the “way they are.”  According to the National Institute of Health, one of the lines in the modern version of the Hippocratic Oath is: I will remember that there is art to medicine as well as science. Physicians can learn the science part (treating the disease) in medical school and residency, but the artistic part (treating the patient) may take a lifetime of practice.
    
So, what types of questions are asked in a spiritual assessment and what is the purpose? The following are some sample questions from the FICA Spiritual History Tool (http://www.aafp.org/afp/2012/0915/p546.html):

1. Faith and Belief: Do you have spiritual beliefs that help you cope with stress? If the patient responds "no," consider asking: what gives your life meaning?
   
2. Importance: Have your beliefs influenced how you take care of yourself in this illness?
   
3. Community: Are you part of a spiritual or religious community? If yes, is this of support to you, and how?
   
4. Incorporate faith in approach to care: How would you like me to address these issues in your health care? (http://www.aafp.org/afp/2012/0915/p546.html)
   

A spiritual assessment is just as important as a physical and mental assessment. How do these three assessments come together to form a plan of care for the patient? Take for example, two patients who experience a motor vehicle accident, which leaves them with numerous injuries, pain and a long path of rehabilitation. Physical: Standard operation includes a physical assessment of each patient’s condition and pain level – it helps in determining the diagnoses and course of treatment. In remembering that medicine is “a science and an art,” the physical assessment (body) might be thought of as the “science” part of medicine because the disease or condition is being treated. At this point, both patients may have equal treatment and a similar plan of care.
    
Moving on to complete the plan of care, the emotional and spiritual assessments may be considered the “art” of medicine because now you begin to treat the individual patient, not just the disease or condition. This is where the plan of care becomes customized and the paths of healing may have different outcomes. We would expect patients, who are more emotionally stable and have more positive attitudes, to have smoother paths to recovery than patients who are anxious, depressed and/or pessimistic. The approach to care requires modification, not judgment. In the spiritual realm, patients who have a sense of purpose in life, a connection to others, and/or believe in a higher power will often be more confident about their recovery. These patients may be more receptive to hope, feeling calmer and more peaceful. The spiritual assessment is relatively simple and not time-consuming and yet has the potential to greatly impact the outcome of the patient’s health status in a positive manner.
    
Although we like to refer the spiritual assessments to the chaplaincy team, it is the doctors, nurses and health team members who can help the patient by utilizing this valuable assessment, showing some honesty, humility, and compassion.
    
In conclusion, when people are struck with illness, the patient outcomes are potentially limited when healthcare providers are preoccupied with only the diagnosis and physical treatment. Illness is a human experience that impacts the lives of our patients on many levels: physically, mentally and spiritually. Our health is not just physical; it encompasses the mind, body and the soul.

Hoping you all have a happy, healthy holiday season and New Year!

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

“According to the Bureau of Labor Statistics, more than 14.3 million people are employed in the healthcare industry, and it’s projected that 3.2 million new healthcare related jobs will be created over the next 8 years… Healthcare is one of the highest growth industries in the entire world” (https://www.careerprofiles.info/growing-healthcare-industry.html).The physician shortage started in the early 2,000s. Within ten years, the United States will see a shortage of nearly 122,000 physicians – not just in primary care but also specialty areas such as surgery (https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage).
      
The reasons for the nursing and physician shortages are partly due to those leaving the professions, but there is also an increased demand for healthcare services. We have more people in need of healthcare because the baby boomers (America’s largest generation) are getting older. Advances in medical technology offer more healthcare options and people are seeking these services, as they add to longevity and the quality of life. The Affordable Care Act has improved access to health care. Retirement is one factor for the shortage, but so is burnout and lack of support, particularly with COVID. Thus, there are more positions opening up, but even the previously occupied positions are not being filled, leaving the public with substantial shortages.
      
Unique to the nursing profession is the wide span of education, and shortages exist in all the below-noted categories. In addition to people not entering the field (or simply not enough), there is a shortage of nursing educators, which forces schools to restrict enrollment.

• LPNs (licensed practical nurses) have one-year of education
• RNs (registered nurses) can practice with just an associate (two-year) degree and in some places nursing diploma programs are still in practice. Many RNs continue on for a bachelor’s degree and the profession’s goal is that at least 80% of RNs carry this out, but only 64% of RNs hold a bachelor’s degree
• Nurse anesthetists, advance practice nurses (nurse practitioners and clinical nurse specialists), and nurse midwives all have graduate degrees (a master’s program)
• Aside from the nursing profession, but an important addendum are CNAs (certified nursing assistants).There has been a long-term shortage in this field. This is the fastest growing occupation in healthcare with a projected increase of 8% within the next decade (https://learn.org/articles/What_is_the_Employment_Outlook_for_a_Certified_Nursing_Assistant_CNA.html)
  

Nurses don’t just work at the bedside in hospitals; there are numerous settings: nursing education, nursing administration, legal nursing, health insurance industry, healthcare consulting, school nursing, long-term care, home-based nursing, public health nursing, nurses in research, telehealth nursing, and varied outpatient facilities (urgent care centers, rehabilitation, physician offices and clinics, etc.)
    
Unique to the medical profession is the residency program. Once medical students complete their education (eight years), they become a medical doctor (MD) or doctor of osteopathy(DO) and must enter a residency program before they can legally practice medicine.
      
There is a system called “matching,” which is carried out through The National Resident Matching Program. This program places a doctor in a residency program; the residency program aligns with the field of interest, such as surgery, internal medicine, radiology, etc. Residency programs are three to seven years in length, depending on the specialty. That means that doctors train for a minimum of 11 to 15 years because many physicians choose to enter a fellowship and do research as part of their practice, which adds additional years of training. For example, some neurosurgeons train for 17 years before they practice in their field.
      
Although there are various reasons that students might not match, one reason is that there are not enough residency slots in this country. This residency unavailability is because of funding restrictions. The Medicare program provides funds for residencies at $10 billion each year (https://www.globenewswire.com/en/news-release/2020/11/20/2130671/0/en/Residents-Medical-Combating-Shortage-In-Residency-Positions-In-The-US.html).
      
Up until the end of 2020, we experienced almost 25 years of a freeze on federal funding for graduate medical education. Finally, Congress passed legislation (effective 2021) to fund an additional 1,000 postgraduate residency programs. However, this process was long overdue and will take time to implement. The 1,000 additional slots still leaves out the 7,000 to 10,000 medical students graduating each year, who do not match to a residency program. That means we have graduates emerging from medical schools, who are MDs and DOs, but cannot practice medicine (https://www.sgu.edu/news-and-events/new-residency-slots-approved-by-congress-what-it-means-for-medical-students/)
    
What do shortages mean in the healthcare industry? We know shortages result in overworked staff. Staffing shortages in the health field compromise the delivery of care, leaving the public with long wait times; increased medical errors, especially with medications; and overall poorer health outcomes; and sadly, increased mortality rates.
    
There are strategies to restore the workforce in healthcare:

1. Promote public health and preventative care (the outcome is that we have a healthier nation, which lowers the need for medical services).
2. Utilize more online degrees to make education more accessible. Of course clinical training is not online, but classroom work can be.
3. Encourage policy changes within human resource departments in order to promote systems for locating personnel, offering on-the-job training, and making it accessible to enter the healthcare field.
4. Improve databases to develop better systems of record-keeping and communication, promote collaboration, and streamline healthcare services. This results in more efficient time for everyone in the healthcare field.
5. Give Healthcare Workers a Voice in Shaping Legislation and Policies since healthcare workers are the most qualified to make decisions about how to change their industry for the better. It is the healthcare worker that should be advising government lawmakers and industry leaders, not the other way around. If doctors and nurses (and others in the field) were taking the lead, we would have more effective clinical settings. (https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/)
   

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

Here is a list of some recent happenings: (If interested many of these stories can be found in Medscape. The online publication is free, but it does require a log-in process).    
     
Death vs birth rates and ICU beds: “For the first time in Alabama's known history, the state's deaths have outpaced its births – a bleak consequence of the COVID-19 pandemic (Medscape 9/20/21). Only 40% of Alabama’s residents are vaccinated. ICU beds in Alabama are being taken up by COVID-19 patients, and the rest of the population is suffering from the consequences. A man, who had a heart attack, found that they were unable to locate an available ICU bed for him in 43 hospitals. A hospital was finally found (200 miles from his home), but it was too late; the man died.
     
Vaccines: “A nationwide study of more than 3,600 adults found the Moderna vaccine does a better job at preventing COVID-19 hospitalizations than the two other vaccines being used in the United States.” Morbidity and Mortality Weekly Report vaccine effectiveness against COVID-19 hospitalization during March 11–August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%),"
     
COVID-19 Boosters: The boosters for older adults and the immunocompromised population have been approved for those people who had the Pfizer vaccine. The protocol for the use of boosters with other types of vaccines is still pending. It is likely that nursing home residents and healthcare workers will be offered boosters, since the risk factors are higher for the elderly and the risk exposure is higher for healthcare workers.
     
Good treatments: According to Lindsay Petty, MD, an infectious disease doctor at the University of Michigan: “A vaccine helps stimulate and prepare your immune system to respond if or when you are exposed to the virus. Your immune system is ready to create all these antibodies before they are needed. In comparison, monoclonal antibodies boost the immune system after you are already sick, speeding up your immune response to prevent COVID-19 from getting worse. But a vaccine does this much easier and much better.”
     
According to William Fales, MD, medical director of the Michigan Department of Health and Human Services Division of EMS and Trauma: You can think of monoclonal antibodies as guided missiles that target and neutralize the virus. But they don't stick around. While monoclonal antibodies are effective for about a month, they are long gone 6 months later, when a vaccine still offers significant protection.” Monoclonal antibodies are also being utilized for short-term prevention in some exposure cases – if the timing is right (Medscape).
    
Bad Treatments: It’s not a good idea to utilize products that are not approved for COVID-19 treatment. Betadine (antiseptic for the skin) and Ivermectin (de-worming) are not approved as COVID-19 treatments. It’s harmful to swallow random medication for an unrelated illness, as well as to swallow a product that is meant for topical use. Although we get frustrated with the regulation process at times, regulations do protect us. After all, who wants to drink contaminated water or eat unsafe foods or take in tampered medications? FYI: And it's worth noting that the US Food and Drug Administration (FDA), the World Health Organization (WHO), and even the drug manufacturer have all recommended against the use of ivermectin in COVID-19. Every health professional knows that you don’t drink Betadine.
     
Healthcare workers misleading the public: “The Oregon Medical Board has revoked the license of Dr. Steven Arthur LaTulippe's,  who didn't follow COVID-19 guidelines in his office and even told some patients that wearing face masks could lead to carbon-dioxide poisoning. His advice to patients amounted to "gross negligence" in the practice of medicine and was grounds for discipline, the medical board said in a report. He also overprescribed opioids for some patients (Medscape 9/22/21)
     
Crisis in Nursing: “The rapidly escalating surge in COVID-19 infections across the U.S. has caused a shortage of nurses and other front-line staff in virus hot spots, who can no longer keep up with the flood of unvaccinated patients and are losing workers to burnout and lucrative out-of-state temporary gigs…. Across the country, thousands of hospitals are overwhelmed with critically ill patients, prompting many overburdened nurses to change careers or retire early. The shortages are particularly dire in rural areas” (https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/09/01/rural-hospitals-cant-find-the-nurses-they-need-to-fight-covid).
     
These are just a few pandemic highlights for this month. By the time this is published, there will likely be even more. We have a choice to learn from our previous mistakes. What can you do to contribute to improve our public health?
     
Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

    Bacteria are complex, tough organisms, single-celled, and have rigid-walls with rubbery membranes for protection. An important difference from viruses is that bacteria can reproduce on their own. Also noteworthy is that most bacteria are harmless and many are beneficial; the bacteria on our skin and inside our body have a protective role and fight off disease. They can also survive extreme environments, whether it is variation in temperature or even radioactive waste materials. Bacteria have existed for over 3.5 billion years (https://www.webmd.com/a-to-z-guides/bacterial-and-viral-infections).
     
Viruses in contrast are small; they do not have a strong cell wall. They cannot survive on their own; they require a host in order to replicate and survive. Most viruses are harmful to humans, and these pathogens attack specific cells in the body such as the lungs, blood and liver.
     
Diagnosing: Is it a viral or bacterial in origin?  With some illnesses, such as colds, a distinction as to whether it is bacterial or viral in origin is not critical; you can “ride out the common cold.” Sometimes a simple examination can determine the source of an infection such as chicken pox (viral) or a staph skin infection (bacterial). Other times a good history can determine the likely infection: influenza during flu season. However, there are other times that a determination has to be made in order to treat a condition such as meningitis, pneumonia, or a serious gastrointestinal infection. The detection approaches are too complex to discuss here, but in general bacterial cultures are more routine since bacteria reproduce on their own and will continue to grow in the petri dish in the lab. Since viruses require a host to reproduce and survive, viral testing often involves eliciting an antibody response, by utilizing such tests as DNA/RNA (PCR) or antigen detection (https://ec.europa.eu/research-and-innovation/en/horizon-magazine/pcr-antigen-and-antibody-five-things-know-about-coronavirus-tests).
     
Treatments: Typically antibiotics are used for bacterial infections and antivirals are used for viral infections. Examples of familiar bacterial infections are: strep throat, Lyme disease, cellulitis, mycoplasma, bacterial meningitis, gonorrhea, TB and tetanus. Well-known viral infections include influenza, common cold, warts, HIV, chicken pox, viral meningitis, viral hepatitis, and of course, now we all know about Covid-19 (https://www.healthline.com/health/bacterial-vs-viral-infections#viral-infection-examples). Antibiotics fight off bacterial infection vs antivirals, which help to alleviate the symptoms but do not totally ward off the viral infection.
     
We tend to take antibiotic treatment for granted. Historically, the discovery of antibiotics was literally revolutionary. Prior to WWII, infections struck down children, the elderly and even adults in the prime of life (http://www.remappingdebate.org/article/return-our-old-enemies-untreatable-formantibiotics). But now we have to be careful with overuse because it can lead to the development of resistant organisms. Remember, bacteria have been around for billions of years. These antibiotic-resistant bacteria (now even stronger) can easily be transmitted to others, and for some people the result is severe disability or even death (https://www.hopkinsmedicine.org/health/wellness-and-prevention/antibiotics). We are in constant need of new antibiotics to counter this problem, but antibiotic development is not a big money-maker. Pharmaceutical companies profit with the production of drugs that have to be taken long-term (i.e., statins) rather than with antibiotics, which are taken predominantly on a short-term basis (https://hopkinsinfectiousdiseases.jhmi.edu/research/research-areas/antibiotic-resistance-and-stewardship/).
     
Here is a list of the most serious life-threatening infections that the Infectious Diseases Society of America (IDSA) has identified as a group of drug-resistant bacteria. The acronym – ESKAPE – is used to represent the fact that these pathogens are “escaping” the effects of antibiotics:
     E= Enterococcus faecium… causes a variety of wound, heart and urinary tract infections
     S= Staphylococcus aureus … causes MRSA
     K= Klebsiella Escherichia coli K pneumoniae… causes common urinary tract infections
     A= Acinetobacter baumannii… causes pneumonia and infections in the blood
P= Pseudomonas aeruginosa… causes pneumonia or infections in the body after surgery
     E= Enterobacter species…. causes colon, other intestinal and abdominal infections
    
Although there are vaccines for bacterial infections, we associate vaccine use with viruses. Vaccines are preventative; they are not a form of treatment like antibiotics or antivirals. Let’s go back to the beginning when I said that viruses (pathogens) need a host (like us for example) in order to live. “The pathogen’s job is to evade the immune system, create more copies of itself, and spread to other hosts.” (https://www.historyofvaccines.org/content/articles/viruses-and-evolution). We can build antibodies to fight off viral infections (like the common cold), but if mutations occur then the virus’ outer surface changes and the previously produced antibodies cannot fight the mutated virus. Because vaccines are given less frequently (prevention) than repeated antibiotic-usage, (treatment) there is not an overuse problem.
     
In contrast, to regular influenza, the Covid-19 virus is atypical because it jumped from the animal-to human kingdom and it has the potential to cause serious symptoms and death. As we know, the bad news is that this resulted in a pandemic; the good news is that  scientists at the National Institute for Health (NIH )Vaccine Research Center (VRC) were already carrying out vaccine studies for years in order to figure out how to develop protection against coronaviruses, which is what Covid-19 is (https://covid19.nih.gov/news-and-stories/vaccine-development). The outcome of those years of research was the development of an effective vaccine. Basically, the mRNA in these vaccines “teaches” our bodies how to build proteins, which triggers an immune response to fight the Covid-19 infection. Unlike other vaccines, no form of a virus (live or attenuated) is used. The mRNA is synthetically produced and cannot enter our body cells. Soon after the mRNA  “teaches” our body to produce an immune response against Covid-19, it dissolves. It cannot exist in body temperatures of 98.6 F; remember that these type of vaccines have to be stored in extremely cold temperatures or they begin to break down.
     
It helps to know how viruses and bacteria are different!
     
Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

The “P” stands for ‘portability,” which reflects the purpose of this act: HIPAA was developed to “modernize the flow of healthcare information” (https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/). To be clear, HIPAA does not result in your health information being totally private and protected; rather, the key purpose is to manage how your health information is handled and transmitted. Here’s how it works.
     
With this act we are able to access our own medical records, authorize others to access our information with our permission and receive disclosure notification when our health information is shared. There are many organizations and companies receiving our health information that have nothing to do with our actual healthcare and everything to do with covering the cost. We are more familiar with signing forms that allow our doctors to share information with other healthcare providers and our health insurance companies. These groups are called “covered identities.”

But we are less familiar with other companies and organizations (beyond the covered entities) who have access to our health information. They are identified as “non-entities.”

1. Credit card companies: If you have travel insurance coverage with your credit card, take a look at your credit card notices about disclosure. They have access to your health information. If you are ill or have an injury while traveling, your credit card company covers the costs. Your privacy goes out the window.
2. Employers

• Worker’s Compensation: If you have a work-related injury or illness, you have no choice but to file the claims through Worker’s Compensation. Now your employer has access to some of your health information.
• Employers may require drug-testing, pre-employment physicals and periodic physicals for high-risk positions (i.e., exposure to chemicals or working with heavy equipment). There are loopholes and some health information is exposed (https://www.policygenius.com/blog/who-controls-your-health-data-a-guide-to-your-rights/)

1. Life, Long-term Care and Disability Insurances, and even Auto and Home Insurance companies: If you want coverage for life, long-term care or disability insurance, you must provide health information upfront as part of the application process. For certain claims with home or auto insurance, your health information might be revealed (https://www.gocompare.com/life-insurance/access-to-medical-records/).
2. Social Security has access to your health records and can obtain them quickly, since this is a requirement for people participating in the disability program: Social Security Disability Program or SSDA  (https://www.ssa.gov/disability/professionals/hipaa-cefactsheet.htm)
3. Law Enforcement: If the police need to identify or locate a suspect, fugitive, material witness, or missing person, they can access health information. They obtain this information through subpoenas, attorney letters, or the individual or family (https://www.hhs.gov/hipaa/for-professionals/faq/disclosures-for-law-enforcement-purposes/index.html)

How do these companies and organizations obtain your health information? It is easy. All your health information (including prescriptions) is stored in what is called “clearinghouses.” Remember signing the form that allows your health information to be shared with your health insurance? Well, your health information needs to be “transported” somehow. Clearinghouses are electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information.
     
This system maintains your Protected Health Information (PSI), which includes 18 elements such as name & demographics, your SS #, dates of all admissions & discharges to hospitals, ERs  rehabilitation centers, etc. But the clearinghouses also maintain a list of all your diagnoses and prescriptions. Yes, they are secure and you have given your permission to disclose this information, but these clearinghouses are also accessed by the above-noted non-entities. For example, when a physician wants to purchase disability insurance coverage (to protect income and family), the clearinghouse provides all this personal health information to the insurance company in order to determine acceptance or denial of the insurance.    
   
There is misinformation in regard to privacy and HIPAA on the other end, such as the times when we find ourselves unable to obtain updates about a family member’s medical condition. However, there are circumstances when a physician can use his/her clinical judgment to disclose information and yet we mistakenly hear “It’s a HIPAA Violation” when it is not (https://betterhealthwhileaging.net/hipaa-basics-and-faqs-for-family-caregivers/).
     
This applies to COVID vaccine status as well. When people ask the question – “Is it a HIPAA Violation to Ask about COVID Vaccines?”- the answer: is “No.” According to the HIPAA Journal: "Any organization can ask any employee, customer, or relevant third party whether or not they have been vaccinated against COVID-19 without violating HIPAA. However, before asking the question, organizations should be prepared for how they will respond to individuals´ answers, or how they will respond if an individual refuses to answer the question” (https://www.hipaajournal.com/is-it-a-hipaa-violation-to-ask-for-proof-of-vaccine-status/). Reminder: The sole purpose of HIPAA is portability, not privacy. Thus, the question can be asked without violation, but caution must be taken as to “how” the information is utilized (For example, one cannot infringe on protocols of the American Disability Act). This is where people get mixed up about privacy and HIPAA.
     
With COVID-related health issues, we are dealing with a public health crisis, and communicable diseases are reportable to the departments of health for our safety. “Protecting the privacy of individually-identifiable health data and promoting the public’s health often seem at odds, but health data are the lifeblood of public health practice “
(https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/abs/health-information-privacy-and-public-health/0D5035F5D7853DAA740921CE8263C0C7).
     
Here in NYS, the following guideline was set on June 15, 2021: Individuals must present their vaccination records if a business or organization requires it. “Unvaccinated or unknown vaccination status individuals who are over the age of four must continue to present proof of a recent negative diagnostic COVID-19 test result and wear masks within the venue” (https://www.governor.ny.gov/news/governor-cuomo-announces-covid-19-restrictions-lifted-70-adult-new-yorkers-have-received-first).
     
In summary, there is widespread misunderstanding of HIPAA, its Privacy Rule and the use of our health information (https://privacyrights.org/consumer-guides/health-privacy-hipaa-basics). People are quick to toss out the phrase – “It’s a HIPAA violation” – when they really have no understanding of its function.
      
For more information, visit the website: https://betterhealthwhileaging.net/hipaa-basics-and-faqs-for-family-caregivers/

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.


Pandemic Highlights7/1/2021
0 Comments

 
I started out writing about the highlights of COVID-19 and with each highlight, the outcome was “people need to get vaccinated.” We have the good fortune in this country of access to the vaccine, and yet we still have large numbers of the population not vaccinated. In the beginning it was understandable that people were concerned about the unknowns of the vaccine, but now there are over 2.5 billion people who are vaccinated world-wide.

For those of us who understand epidemiology, we know the reason for this dilemma has nothing to do with being rational. For example, people think nothing of hopping in and out of their cars, which runs a much higher risk of injury or dying than being vaccinated. People are uninformed about public health and safety. Don’t we benefit from safe drinking water, uncontaminated medications, and food labels? The solution to many of our problems and confusion about the pandemic would be resolved if people got vaccinated. People from other countries, who do not have the access to vaccines like we do in the U.S., think of our citizens as foolish and privileged. If people cared about others, our society and our future, they would get vaccinated.
      
The more we read about the dynamics of the virus, there seems to be conflicting and confusing reports. To help clarify what is going on: It’s not that the science is wrong. But rather, the virus is brand new to homo sapiens and it has caused a large-scale crisis worldwide. As with anything new and on such a massive scale, there is a learning curve. Bottom line, we simply have to remember that we are living through a pandemic. Shouldn’t we be grateful that we are among the living? Worldwide – as of this moment – 3.8 million people have died from COVID-19. We are fortunate to have vaccines that are highly effective and are keeping us safe.
      
As I write this, NYS (mid-June) is lifting most of its COVID restrictions because the “70% vaccination benchmark” has been reached (meaning 70% of NY’s population has had one vaccine). But in contrast we are also “crossing the 600,000 milestone” of deaths from COVID in the U.S., which reminds us that the virus is still spreading and that there are still too many people unvaccinated.
      
Let’s address some of the highlights. With all the issues that crop up about COVID, the solution to the problem is prevention from getting ill, which means getting vaccinated:

1. The bad news is that we have variants. The good news is that the vaccines are highly effective in protecting against these variants, thus far. This gives us another reason to support getting vaccinated (https://www.medscape.com/viewarticle/953057?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
2. Large numbers of patients (100,000s) are seeking medical attention (physical and mental) for post-COVID health problems. We just do not know how long or how severe these problems will be. Again, to prevent the continued problems and complications of COVID, all factors point to getting vaccinated (https://www.nytimes.com/2021/06/15/health/covid-19-patients.html).
3. The Antiviral Program for Pandemics is not just for the coronavirus, but for viruses that could cause future pandemics. Our current vaccines for COVID-19 were more readily developed because scientists were already researching this area years ago.
4. Although we are in the infancy of research, pregnant woman are safely getting vaccinated with no complications such as preterm delivery or other adverse pregnancy outcomes (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html). In contrast, the various risks related to the COVID illness during pregnancy are more severe than the vaccination risks. This includes the fact that the risk of getting a more severe case of the disease during pregnancy is much higher. The fact that pregnant women are being vaccinated demonstrates a high safety level.
5. A federal judge in Texas has dismissed a lawsuit from 117 Houston Methodist Hospital workers who refused to get a COVID-19 vaccine. It was considered a "frivolous lawsuit” and the judge upheld the hospital's policy that the vaccination requirement didn't break any federal law. Methodist is trying to do their business of saving lives without giving them the COVID-19 virus," he wrote. "It is a choice made to keep staff, patients, and their families safer.” (https://www.medscape.com/viewarticle/953040?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
6. Some businesses are choosing proof of vaccination in order to operate. This includes numerous healthcare facilities (mandatory for employees), wedding venues, some fitness centers, or places where retreats and workshops are being held. These businesses do not want to run the risk of a COVID outbreak for both safety reasons and economic purposes (it could destroy their reputation if word got out about a COVID outbreak ).
7. Because not everyone is vaccinated, we have the predicament of “Do we wear a mask or not?” If you are vaccinated, the answer is often clearer for some situations, such as not needing a mask at a gathering where everyone is vaccinated. But in public places, where there is a mix of vaccinated and unvaccinated people, it becomes muddy. Overall, it’s a good idea to wear a mask when there is a situation that presents with a higher risk for viral transmission, such as large gatherings in closed spaces with poor ventilation and people who are not vaccinated.

  
It makes sense to wear a mask
(https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-social-activities.html#event):

• When using public transportation (planes, trains, buses, etc.)
• When using gym and fitness facilities where heavy breathing takes place in tight quarters
• When the business or organization requires the protocol (after all, a restaurant can post “no shoes; no shirt; no service”)
• When a person who is not vaccinated will be around multiple unknown parties of people indoors, and especially if social distancing is a challenge.
• In settings where yelling, chanting or singing takes place
• When a person is immunocompromised or has other health risks
• When a person is currently not feeling well and wants to be careful
• When traveling to unknown areas where there might be outbreaks of COVID-19
• When traveling to areas that are known to be experiencing outbreaks of COVID-19 variants (https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html)

In my professional opinion, not being vaccinated for COVID-19 (unless contraindicated, of course) is a foolish and selfish decision.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

For those of us who understand epidemiology, we know the reason for this dilemma has nothing to do with being rational. For example, people think nothing of hopping in and out of their cars, which runs a much higher risk of injury or dying than being vaccinated. People are uninformed about public health and safety. Don’t we benefit from safe drinking water, uncontaminated medications, and food labels? The solution to many of our problems and confusion about the pandemic would be resolved if people got vaccinated. People from other countries, who do not have the access to vaccines like we do in the U.S., think of our citizens as foolish and privileged. If people cared about others, our society and our future, they would get vaccinated.
      
The more we read about the dynamics of the virus, there seems to be conflicting and confusing reports. To help clarify what is going on: It’s not that the science is wrong. But rather, the virus is brand new to homo sapiens and it has caused a large-scale crisis worldwide. As with anything new and on such a massive scale, there is a learning curve. Bottom line, we simply have to remember that we are living through a pandemic. Shouldn’t we be grateful that we are among the living? Worldwide – as of this moment – 3.8 million people have died from COVID-19. We are fortunate to have vaccines that are highly effective and are keeping us safe.
      
As I write this, NYS (mid-June) is lifting most of its COVID restrictions because the “70% vaccination benchmark” has been reached (meaning 70% of NY’s population has had one vaccine). But in contrast we are also “crossing the 600,000 milestone” of deaths from COVID in the U.S., which reminds us that the virus is still spreading and that there are still too many people unvaccinated.
      
Let’s address some of the highlights. With all the issues that crop up about COVID, the solution to the problem is prevention from getting ill, which means getting vaccinated:

1. The bad news is that we have variants. The good news is that the vaccines are highly effective in protecting against these variants, thus far. This gives us another reason to support getting vaccinated (https://www.medscape.com/viewarticle/953057?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
2. Large numbers of patients (100,000s) are seeking medical attention (physical and mental) for post-COVID health problems. We just do not know how long or how severe these problems will be. Again, to prevent the continued problems and complications of COVID, all factors point to getting vaccinated (https://www.nytimes.com/2021/06/15/health/covid-19-patients.html).
3. The Antiviral Program for Pandemics is not just for the coronavirus, but for viruses that could cause future pandemics. Our current vaccines for COVID-19 were more readily developed because scientists were already researching this area years ago.
4. Although we are in the infancy of research, pregnant woman are safely getting vaccinated with no complications such as preterm delivery or other adverse pregnancy outcomes (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html). In contrast, the various risks related to the COVID illness during pregnancy are more severe than the vaccination risks. This includes the fact that the risk of getting a more severe case of the disease during pregnancy is much higher. The fact that pregnant women are being vaccinated demonstrates a high safety level.
5. A federal judge in Texas has dismissed a lawsuit from 117 Houston Methodist Hospital workers who refused to get a COVID-19 vaccine. It was considered a "frivolous lawsuit” and the judge upheld the hospital's policy that the vaccination requirement didn't break any federal law. Methodist is trying to do their business of saving lives without giving them the COVID-19 virus," he wrote. "It is a choice made to keep staff, patients, and their families safer.” (https://www.medscape.com/viewarticle/953040?src=mkm_covid_update_210614_MSCPEDIT&uac=64796DZ&impID=3441982&faf=1).
6. Some businesses are choosing proof of vaccination in order to operate. This includes numerous healthcare facilities (mandatory for employees), wedding venues, some fitness centers, or places where retreats and workshops are being held. These businesses do not want to run the risk of a COVID outbreak for both safety reasons and economic purposes (it could destroy their reputation if word got out about a COVID outbreak ).
7. Because not everyone is vaccinated, we have the predicament of “Do we wear a mask or not?” If you are vaccinated, the answer is often clearer for some situations, such as not needing a mask at a gathering where everyone is vaccinated. But in public places, where there is a mix of vaccinated and unvaccinated people, it becomes muddy. Overall, it’s a good idea to wear a mask when there is a situation that presents with a higher risk for viral transmission, such as large gatherings in closed spaces with poor ventilation and people who are not vaccinated.

  
It makes sense to wear a mask
(https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-social-activities.html#event):

• When using public transportation (planes, trains, buses, etc.)
• When using gym and fitness facilities where heavy breathing takes place in tight quarters
• When the business or organization requires the protocol (after all, a restaurant can post “no shoes; no shirt; no service”)
• When a person who is not vaccinated will be around multiple unknown parties of people indoors, and especially if social distancing is a challenge.
• In settings where yelling, chanting or singing takes place
• When a person is immunocompromised or has other health risks
• When a person is currently not feeling well and wants to be careful
• When traveling to unknown areas where there might be outbreaks of COVID-19
• When traveling to areas that are known to be experiencing outbreaks of COVID-19 variants (https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html)
  

In my professional opinion, not being vaccinated for COVID-19 (unless contraindicated, of course) is a foolish and selfish decision.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.

Moving helps to reduce stress, depression and anxiety and improves learning, memory and cognition. According to neuroscientist, Shane O’Mara: “One of the great overlooked superpowers we have is that, when we get up and walk, our senses are sharpened. Rhythms that would previously be quiet suddenly come to life, and the way our brain interacts with our body changes” (https://www.theguardian.com/lifeandstyle/2019/jul/28/its-a-superpower-how-walking-makes-us-healthier-happier-and-brainier l).
     
For most of us, walking is fairly manageable and easy to do. But it is actually a complex cognitive task. There are mental gymnastics going on when we simply hike into the woods, stroll along in the city, or take a walk through the park. Think of all the maneuvers the brain goes through; a sophisticated robot cannot do it. Walking also changes how we think and feel. In O’Mara’s book, In Praise of Walking, he claims that “just crossing a street is pretty miraculous” (https://www.inc.com/jessica-stillman/neuroscientist-walking-is-a-superpower-that-makes-us-smarter-healthier-happier.html). The bottom line, the uniqueness of humans is that we walk upright on two feet, and we are supposedly on the top of the food chain with our intelligence.
     
Let’s look at the following brain functions: Smarts (cognition), memory, creativity, emotions (happiness, depression, etc.) and personality.
     
Cognition: According to Harvard psychiatrist and author, John Ratey, exercise (like walking) makes you smarter. There are many studies, but in one Swedish study of 1.2 million boys, starting at the age of 15 and then evaluated again after military training at 18, it demonstrated that as they got fitter, their IQs, increased. This was also true for identical twins, when one increased their exercise and the other did not. And finally a study, done in Texas with 2.6 million children, showed a strong correlation between fitness levels and grades, regardless of demographics (https://www.inc.com/jessica-stillman/how-to-use-exercise-to-optimize-your-brain.html).
     
Memory: The brain systems for cognition, memory and therefore learning are all the same. It is much like a GPS system and it is called cognitive mapping. Even more interesting is that there are overlaps with movement and cognitive mapping. “Rhythms that would previously be quiet suddenly come to life, and the way our brain interacts with our body changes” (https://www.theguardian.com/lifeandstyle/2019/jul/28/its-a-superpower-how-walking-makes-us-healthier-happier-and-brainier).
     
Creativity: One type of brain frequency is called theta. Theta is a pulse or frequency that is seen all over the brain during the course of movement. In addition to general learning and memory, theta frequencies improve spatial learning, which entails design, the visual arts, drawing, painting, as well as figuring out puzzles and charts. Basically this represents our creative abilities and the ability to think abstractly.
     
Emotions: We know that walking and other physical activity helps counter depression and reduce stress. But how? Many studies are addressing this topic and scientists have determined that just like antidepressants do, walking and other physical activities literally increase the amount of neurotransmitters in our brains (https://www.inc.com/jessica-stillman/how-to-use-exercise-to-optimize-your-brain.html). So, walking acts like an antidepressant. Also neurogenesis takes place when we exercise, which means we build new brain cells. This is a fairly new concept; not that long ago it was thought that the number of brain cells we had was preset.
     
Personality: Physical activity helps to change aspects of our personality. With movement we tend to be less sluggish and we can think clearer. Physical activity helps to ward off anxiety, stress and distractions and we become more focused. As we discussed with the other brain functions that are improved with physical activity, there is a culminating effect on personality. When we function better cognitively, emotionally, and creatively, we tend to become more open-minded, less grumpy and more approachable. Our personality has the potential to change (https://www.realsimple.com/health/mind-mood/what-happens-to-brain-without-exercise).    
     
What sort of exercise is good for the brain? What’s good for the heart is good for the brain. To help stay motivated, it’s best to choose the physical activities that you enjoy or those that make you feel good. The simplest and often most natural exercise is walking. Although considered simple, walking  requires a harmonious coordination of your joints, muscles, bones and nerves, involving some 200 bones and 600 muscles. The muscles in our internal organs and blood vessels are also at work in conjunction with what we call nerve ganglia. These ganglia are sometimes referred to as “little brains.” We are also working our senses and sending constant messages to the brain about what we touch, see, smell and hear and then we have to process those messages. Although not consciously, each step  takes enormous amounts of information to travel to the cerebral cortex, using sensory and motor neurons. We are processing information just to address the change in road or ground surfaces, as well as all the other instructions that the brain has to carry out to climb a mountain, cross a street or weave in and out of crowds of people (https://brainworldmagazine.com/walking-is-brain-exercise/).
     
One step requires lots of brain power, and each step moves you toward a super brain.

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.