Posts filed under janet's writing

Super Nurturer

35 bday with my 3 angels 001-1.jpg

[Photo by friend of Janet and family.]

A talent I did not know I have is caring for others. Those that have known me a long time are laughing right now, I hear you! Apparently, I came into this life with this innate understanding of how to remove myself completely in crisis in order to help another. But, honestly, I did not recognise this until after years of people reflecting this to me in specific situations. In fact, I still perceive I am not perfect in any way at this giving thing.

Okay, why talk about it now? Some of you are aware that my husband and I lived with and took care of his mother full time as she died over the last five years. I will come back to that dying over five years in a moment. Now, his only brother who lives down the street from us has turned a corner in his ability to care for himself. Yes, he has kids, no wife, but caring children. As fate would have it, their lives are overwhelmed with new children right now.

I understand most people say things like, ‘why do it? Isn’t there some system in place to do that instead? I don’t have time. I am no good at that.’ And for every individual these answers matter. We all must follow our own path. In my path, I did not see any benefit in this tendency of mine. The big Clan I grew up within simply utilized all members to take a part in caring for the Whole. Sweetly, there were more than enough of us that no one was pressed into family duty beyond the level of their maturity.

On becoming a mother, however, the mystery of wholeness unraveled. Again, pressed into duty! But on a level about which I had no comprehension. Early on when my husband could not take the sleep deprivation, he just walked out. Slammed by the sudden realization, I perceived: the buck stops here for who else is going to care for this tiny newborn? I would like a break too; but there is. no. one. else.

Nurturing life from its onset revealed hidden rewards…because I wanted them, I looked for them, I Needed them. These rewards became gems that I learned to cling to, as all my own childhood dreams fell to the wayside. Unknowingly, I built a repertoire of skills… in unconditional service. Where did I come up with this? In retrospect, I see how every example and role model of unconditional Love and mentorship that I had received, floated to the forefront of my awareness. I used these moments, again, because these were all I had to survive.

Yes, Janet, but you do have a choice. O yes! I do. That is the crux, is it not? All along anyone’s path comes moments for choice. Why did we take whatever fork in the road we took? Some years ago, a very special mentor of mine asked me a most vital question. He said, Janet, you are such a good nurturer, so much so that you are a super-nurturer… but, perhaps what is more valuable and pertinent to your own growth is when are you going to turn that super-nurturing around and apply it to your Self?

Back to how, above, I phrased the description of our care for Mum … “dying over five years.” What do I mean – Five Years?! Consider, if you will, this choice idea… when you contemplate where you are in your life’s goals or whether you ought to consider having some goals! What is the purpose of life, of being born at all? Nothing at all against anyone avoiding giving service to others; the popularity of that trade is declining. There certainly seems to be quite a few examples of service to Self these days.

As I have written many times, what does your life amount to when your turn comes to die? When do we begin to die? And, if one is avoiding it, what exactly are you avoiding? Why? Though we may have many people by our bed as we pass from this life, only one person dies, only One gives up the outer world. Will you have discovered a way to fill your chalice with meaning that keeps you, true You, whole through such a crisis as your own death!

What if the meaning of life is far more multi-dimensional than collecting a pocketful of trinkets… There is a mystery! In my viewpoint, consciousness is the child that, like all children, requires nurturing. We do not even take anything from this life when we die, except consciousness. If you have not experienced freedom of consciousness … to choose, say, not being dragged down by others’ negativity or to find a way around obstacles and fixed conditions, I have a pertinent suggestion for you. … …

One of my mysterious gems: learn who this consciousness is… and nurture it.

Posted on October 12, 2018 and filed under janet's writing, visions.

Momentum Despite Resistance

walkabout beach.jpg

Changing your lifestyle meets resistance from the outer world in odd and surprising ways.

Anyone trying to lose weight is well aware of this resistance! One's very own body seems to rise up like Darth Vader standing in your pathway. Like a monster in your dreams, former unhealthy choices hound the best laid plans. Hunger, cravings, comfort foods, and well meaning friends and family seem to come out of the woodwork carrying temptation on a platter ... a very 'yummy-looking' platter. Help! the dieter is heard moaning, as he/she crumbles again. And asks me, "What momentum?"

To achieve momentum despite resistance, the hopeful healthy soul could use some back-up. Self awareness, educated support, clever strategy... all are truly beneficial. But in my journey to health at a new phase in my life the last decade, I hit upon something almost akin to magic! that made this whole temptation thing see-through, basically stealing my habits' power away. Hunger. in Real satiation! I mean to say, satisfying my body's hunger. Let me explain...

I knew that, since my teens, I had not actually felt real hunger anymore. My teen years is the timing of when the whole low-fat fad became promoted. My family, being good folk that wanted to support health for the whole family, fell right in with the new protocols. Of course they did! Low fat options were somewhat limited initially, but the big labels got busy filling the gaps. Shortly thereafter, my athletic teen body started putting on weight! Heaven forbid! I was a follower of Seventeen magazine! Fat was simply wrong, so I set about dieting at the tender age of 14.

Long story short, my own cycle of dieting, weight gain, dieting began.... but also, a constant search for the true healthy way to eat. I tried everything, vegetarianism, veganism (12 years of it), pescatarianism, fruitarian, fasting regularly, Atkins & South Beach, macrobiotics, more.... the list is too long! Through it all, I never actually experienced real hunger again (yep, even fasting). Years later, after nearly starving myself for years, and more overweight than ever!! I took a good long look at myself in the mirror before my birthday. I did not recognize this body. Thinking of my kids as well as personal goals, I made a covenant to get after nutrition research more deeply yet.

Deep research meant current research as well as research into the history of how we arrived at the current conflict between research, disease, lifestyle, regulatory bodies, and food manufacturers. As I read, I followed a mostly macrobiotic style of eating and worked hard at losing weight, working out, exercising, and firmly refusing temptation. Still I only lost 9 and 1/2 pounds in a year. Meanwhile, I discovered this thing called Banting; also known as High Fat Low Carb (HFLC), ketogenic diet, and a host of other names. Suspiciously, this sounded so much like how my family ate BEFORE the low fat fad took off. When my spouse took off for a long work trip, I took the alone time to try out Banting.

Bottom Line: In the following four months, I lost 40 pounds.

Holy Moly! Now I remembered hunger... NOT from starving but from satiation! Real satiation of my body's nutritional needs. Happy satiation that made cravings disappear! Satiation that made when and how much to eat vividly obvious.  Coinciding with this wonderful experience, energy returned, mental clarity returned, frequent illness and allergic inflammation became minimal now, and the chronic pain of an old back injury with its associated fibromyalgia and rheumatism dialed down to very tolerable.

Lifestyle Modification Support (LMS) has been sharing the research some years now in these blog pages. So, I will not take this blog to go over it right now. But I would like to share a heartfelt post from someone who has recently experienced success. This share comes through the twitter community that is very active around HFLC (See Richard Lesar's happy tweet in the photo below). I also would like to share some of the resources 'out there' of medical and nutritional experts spreading this way of eating in detail.

The last thing I want to share is, as ridiculous as this is going to sound, I actually already knew of how to use ketogenics for medical reasons. In my nursing and medical practice, I referred certain patients to specialists who advised this very diet to manage epilepsy, inflammatory conditions, diabetes, and rapid weight loss management for those scheduled to go through bariatric surgery. But as I described above, my own body's long journey away from balanced health had become a monster I could only run from, rather than face. I had to turn around and face my monster directly, with dead seriousness. What is it going to take for you? to stop running scared and make a controlling decision to face down your overwhelming reason for dieting?

I wish you all the Best in your goals of rediscovering Balance. If I can answer questions or help you find what you are looking for to accomplish your goal, please contact me and ask. I am honoured to help.

Photo of Richard Lesar’s excellent results taken and used with Richard Lesar’s permission.

Photo of Richard Lesar’s excellent results taken and used with Richard Lesar’s permission.

Posted on April 17, 2018 and filed under discussions, janet's writing, resources.

FAT - the old New Truth about healthy eating

Smile... there is always a way to find balance! [Photo by Wylan Werth]

Smile... there is always a way to find balance! [Photo by Wylan Werth]

What is UP with the news lately? How to make heads or tails of it? Eat Fat? not sugar.... and Sugar DOES cause obesity, and can lead to diabetes, hypertension, poor immune response, as well as contribute to a host of other diseases "on the rise" since the 1960s. As usual, all the news stories can become a bit heady. Stick to the basics. But what are the basics anymore? (Be sure to click on the orange lettered link above the kewt kitty photo! for a very informative video by Dr Robert Lustig about fat's role in Your Good Health).

And read labels! Another necessity to be healthy??? The trick on us has been exposed. Reading labels is the only way to get ahead of eliminating sugar from your diet. But no worries! Right here in this blog, and in the blogs of many many others sincerely doing our best to get the info in your hands and the healthiest food In your body, the science is revealed. Food manufacturers can rename sugar and even place it lower in the ingredient list by splitting up the types of sugar they added to a food substance to trick your tongue and brain into ...WANTING MORE.

Bottom line: In late 1950s, early 1960s, some research about the impact of eating sugar was brushed under the rug. The sugar industry paid some influential folk to say that fat is the problem-causing substance, not sugar. [ See these links as well as others provided throughout Lifestyle Modification Support : Sugar Lobby Paid Scientists to Blur Sugar's Role... and JAMA's articles ] Then food manufacturers got busy! Changing food into food substances that would be so addictive (as the lab rats revealed) that people just could NOT get enough became as easy as train robberies in the old wild west!

So, if you cannot get enough of that food you are eating, ask yourself, what about this experience is any different than being hooked on drugs, alcohol, or gambling? We do have the chemistry to become an addict. We also have consciousness, if we wake up and decide that: balanced and healthy, life might actually be doable. If we do decide we have at least an obligation to do the best we can do, we can make an effort to use REAL science to return to health. And realise something really sweet.... You have been doing your best. But misleading information has been hand-fed to you. Question authority! Do NOT take my word for it. There is so much information now, there is not far to go to find it. The video that I began this article with, Dr Robert Lustig's third episode on "The Skinny On Obesity" is made for regular people to listen to and understand. And go to your search engine and start looking up things like "Whole Fat" and "The Sugar Problem"...

One more thing, before I go. I cannot reiterate enough that low fat products have LOADS of Sugar in them! Look up the many other names for sugar that can be used on the ingredients lists of foods. STOP eating low fat foods! That is, stop eating them, if your goal is to lose weight and, literally, feel much much better.

Be Well, friends

Janet's Eye on the media

Janet's Eye on the media

Posted on March 12, 2017 and filed under discussions, janet's writing, Research studies, information.

Protect Your Gut! for your gut protects you...

Pearl the Golden... loving the sands and Ocean... origin of our elemental bodies.

Pearl the Golden... loving the sands and Ocean... origin of our elemental bodies.

If you are reading this site for the first time, you either are wondering when I might get off this subject!! Or you are curious as to how I could be making such a claim as this: Protect Your Gut! for your gut protects you...

I am including yet another review of the ongoing, ever blossoming revelations, of research on just how vital our gut's ecology is to our physical well being. In fact, there is an increasing body of data to support that the microbiome of the gut is very much the contributor to our mental well being as well.  So, please, dear readers, read these shares and contributions on the widespread expansion of knowledge regarding the intricacies of how to support your intestinal health in order to improve many many types of symptoms you may be experiencing... especially this upcoming winter season in the northern hemisphere.

And, always, dear readers, Be Well!

From Shann's Chuckling Goat site.... "Scientists have found that supplementing with probiotics can: 

  1. Shorten the duration of cold by two days
  2. Lessen severity of cold symptoms by 34%
  3. Result in a higher quality of life and fewer missed school days 

"Probiotics are secret weapon for fighting symptoms of the common cold in college students, study suggests."  - University of Medicine and Dentistry of New Jersey (UMDNJ)."


Posted on September 23, 2016 and filed under janet's writing, discussions, Research studies.

How We Survived

Photo by estt/iStock / Getty Images

How We Survived


Today’s hunt nearly cost us our two youngest stalkers, the promise of tomorrow lives in their strength and cunning. We have been without sufficient food for two days. How much longer can the young ones be convinced to share any harvest with all of us? I can only hope the gatherers succeeded in discovering a good supply of roots or our families may not remain alive to see another full year.


Astounding to imagine what survival entailed on a day to day basis in the formative years of our species’ evolution. Yet survive our species did, or we would not be overrunning the planet today. Was it merely persistence and blind luck? There are many theories; however, there is consensus that our intelligence assisted in our ability to learn from mistakes and discover what foods were the easiest and safest to rely upon to awaken to another day….by day …by day.

What if we had insisted on eating food-like substances with little or no nutrient value, would we have succeeded to the degree we realise now? When early hominids consistently ate lesser quality substances, they tended to sicken, starve or weaken so much so that their care became a burden. Some of these unfortunates did manage to reproduce, but courtship rituals for early hominids had to be much like all mammals reproduction rites: a display of the traits most likely to provide success for the offspring. In our case, physical prowess is vital but equally so, applied intelligence still stands strong.

Correct or not, the fact of our present survival insists that our sentience played an important role. This utilisation of problem-solving, memory, and experimentation is the outstanding feature of our species that we believe guides our choices even now. Without diving too deep into future conjecture, this article is to open discussion on the purpose of Lifestyle Modification Support’s choice of health articles. Because, in order to sustain our species’ survival record, we surely cannot leave behind all practical use of our intelligence!

Oxford Dictionaries defines intelligence as “the ability to acquire and apply knowledge and skills” (Oxford Dictionaries, 2015). Thus, the popularity of books, periodicals, videos, blogs and social media reflects our inherent appetite for knowledge. You might object that such mediums do not necessarily lend any credible information. Acquiring knowledge certainly requires astute discrimination of the source of information. Whether the information is empirically derived or the product of an active imagination lends further cred to its long-term usefulness. I have heard some argue that knowledge is useless if misunderstood or simply not applied.

Services page link

About page link

With all these implicit parameters embracing Lifestyle Modification Support’s intentions, the goal and purpose of all the health articles available in our website are to assist the individual with a steady source of defining research on balanced lifestyle, especially in the area of choosing Real nutrition to support your body’s intelligent chemical homeostasis. When you are healthy, your future and that of those relying on you is secured. Many readers are educated and practiced at application of knowledge; others require support. Please know that Lifestyle Modification Support is available to answer your individual questions; to speak or write for your educational events; and/or to provide professional advocacy/guidance on a case by case basis. The Services page and the About page offer contact details.



Oxford Dictionaries (2015). Intelligence, retrieved from:

Posted on November 17, 2015 and filed under janet's writing, discussions, mission statements.

Longevity Only for the Wealthy? Why?

"The biggest healthspan concern is Alzheimer's, which strikes at a 47% rate among the over 85 population.

"If we just keep living longer, but we don't knock out this horrible disease, it will be the sinkhole of the century," Dychtwald says. "It will take us down - every country. It will be a horror beyond horrors. And how much do we spend for research on this disease? Hardly anything.""

Learning first hand what a tough & invisible disease this is. . . and, to my perspective, seems very preventable. I hope you do not have to go through this with one of your loved ones, but chances are very strong (47% see quote above) that you or your loved one will! So WHERE exactly are our funding dollars going? Jus' sayin'....

Hipster LucyBear
Hipster LucyBear
Posted on May 31, 2015 and filed under discussions, janet's writing, visions.

Research smee-search, what does it mean?

¬¬¬¬¬  I've written this description of research in answer to the oft repeated statement of friends and family that they do not know what research really is. In healthcare forums, some reveal their lack of awareness regarding research's place in science and in healthcare by the nature of their comments. Sharing this description also emphasizes the standard which I strive to match or exceed in my written discussions. Rationality and objectivity are valuable tools, especially when the well being of others is relying on conscious leadership. Though research/science is imperfect being of the physical world; we nevertheless must make some standard by which to provide the highest possible action in the given moment. ¬¬¬¬¬     by Janet Still MSN FNP

Research is a diligent, controlled study that validates and refines existing knowledge and develops new knowledge. The ultimate goal of research is the development of an empirical body of knowledge for a discipline or profession.  Research is essential to develop and refine knowledge that can be used to improve clinical methods of care, for example.  Young, smiling female doctor in a white coat. What some simply call "science" is the practice of this type of detailed and recorded observation, which is then analysed and compared to many (hopefully) other studies to draw a yet newer overall picture of the studied method/practice.

Critical thinking, developed and practiced, is essential to analysis of research results. So, setting up a formal study of a treatment or methodology for giving care for specific illness must consider carefully how to prevent "noise"  in the observations as well as in the reading and the application of results. Many procedures have been created for insuring unaffected and non-biased studies. These various procedures are the result of continued analysis too. Critical thinking, then, refers to a process of ordering thought such that reasoning is reliable and inarguable.


The professional that provides specialize care must have the ability to provide exceptional physical assessments as well as good critical thinking to assist patients in serious and unstable conditions to reach their maximum health. You might say that goes without question...yet perhaps one should question this very situation! There are as many angles to scrutinizing your healthcare situation as there are words in this sentence (entirely too many haha). I have written on this topic in a number of philosophical articles in this blog. But practically speaking, what matters is what works; and I, like other healthcare providers and experts, have come to recognize that the patient at the center of decision-making is key to effective treatment.


Communication is integral in healthcare on levels too many to attempt enumerating in this article. Understanding the basis of treatment....research studies least a basic understanding, is you-the-patient's tool for assessing the validity of a treatment choice. As always, at the bottom of this article, I will include some resources for you to have in hand for those treatment discussion clinic appointments.

Despite the suppressed groan of healthcare workers and providers on seeing the patient arrive, armed with education of all things! you-the-patient are the primary decision-maker regarding your care, whether you abdicate your power or not. So their reaction expresses either their lack of understanding or their poor communication skills in previous encounters with educated patients. Let me insert here, especially for healthcare providers scanning this, that you-the-patient are not the expert on the latest research just because you found some articles. You are the expert on You, on what works for your balance in your life, on interpreting an illness' priority in your life, and on what amount of surrender you are willing to experience in a health crisis. The healthcare providers are your tools - to interpret pertinent research, to explain options in care, to find you the best specialists available at your behest, and/or to provide you the treatment that you both agree is most suitable given your unique circumstances. (See the References below for current thought on patient-centered healthcare).


Portrait of happy business people with thumbs up against white background

One last example to flesh out the reasoning behind understanding research.... statistics. Ugh, one might comment, meaningless numbers. And I agree the numbers out of context are quite meaningless. Recently, my partner in a documentary presentation of chronic pain asked me why the total numbers given of the condition have such a wide disparity. He could not understand how to present such a spread when speaking of the occurrence of the condition. There are key pieces to creating a research study. One piece is what is called the sample. The sample is how large (or small) the number of subjects in the study. The media is fond of headlining big or small numbers for capturing your attention. But the number is meaningless unless you know how many people were actually studied. In other words, stating that 80% of subjects studied improved with a drug is not so sensational when you read further and learn only ten people were used in the study. Another study with a much larger sample of the population might (probably would) have a much smaller percentage result. There is even more to this number were the subjects decided upon? what age group? what gender? what region of residence? on and on.... so many conditions that can affect the outcome.


Another piece that causes seemingly wide gaps in given results of formal studies is when was the study performed? Was the study you are reviewing for a particular nation? or global? What exactly is the study attempting to define? and what you are looking for? Like any internet search, the keywords determine the results. So before you begin to look for answers, define your question as concisely as you can in order to actually obtain some good leads. If you are coming up with widely diverse answers, why? Maybe this is a question for your provider as well. Yet, you may not be paying attention to details like how old the information is (look at dates on your links!), what aspect of the condition the research was designed to study (cause, symptomology, treatment, epidemiology), do you have the correct title of your condition (diabetes one or two give very different results).


To encapsulate the point of this brief essay: research is meant to establish the most reliable observations of the current day on particular conditions or organisms. Of course research is of multiple disciplines, astronomy, biology, mathematics and physics, genetics, environmental mechanisms, and more. And research is an ongoing, ever dynamic study analysis of the discipline or of the there can be and ARE changes in the accepted thought and practice, based on research. In this essay, I attempt to provide another way of perceiving research that directly impacts You. My viewpoint is take all research "results" with a grain of salt as my grandparents used to say. And look further, deeper. Who funded the study? Did anyone building the study's design have reason to desire one outcome over another? Were the methods used of the highest standard today? and how do you know that? But finally, as always, get some varied expert opinions on the study results. And do not take the first opinion out of the gate! This is your life. Make it taking part in the decision-making.




A quirky but informative (and short) video explaining the very basics of research by Greg Martin with Global Health: This is the first of several he produced to elucidate what is research and research methods. Essentially, he puts research in context in the world.

For a really fun learning experience the Khan Academy has raised the bar. A father wanting to help his son with mathematics has turned into a hugely popular online interactive virtual lesson platform. Keeping on topic with healthcare, I am providing you the link to the Biology school: Know that Khan Academy is known for its comfortable, friendly and fun demeanor making all "lessons" easy as a game.

In the interest of possible avenues to figure out what the heck my doc is talking about to cute questions my kids ask to well what is this symptom about anyway, Its The Small Things offers some readable info on things we cannot see but sure can feel!

On a more serious note, how about a reliable source for research studies more likely to be reliably performed? The Cochrane Library is widely accepted as a reliable peer reviewed source to locate many many MANY research studies. This video helps you learn how to find it and how to use it:


De Silva, D. (2011). Evidence: Helping people help themselves; from The Health Foundation; 52. Retrieved from:

Epstein, R., Fiscella, K., Lesser, C., & Stange, K. (2010). Why the nation needs a policy push on patient-centered health care; Health Affairs 29(8); 1-7.

Institute for Patient and Family Centered Care (2014). Useful links. Retrieved from:


Posted on April 18, 2015 and filed under discussions, information, janet's writing, Research studies.

The Age Old Debate

The Age Old Debate by JStill

hats in Devon
hats in Devon

“Old age is mostly genetics according to latest findings, but what condition one arrives to old age is the difference between thankful for your genetics or very sorry,” I imagine telling my offspring. No, that is not going to come across …gently. How to say it? “Having the genes for living long does not infer enjoying the late years…” Blek! Why would they listen? What has this bug under my skin now anyway? Long and short of it is that I have been living 24/7 with a 92 year old for the last four and a half months… and this has been a very sobering experience. 

Here is the scoop: I am a medical provider by trade and formal education, a holistic advocate and educator by cultural tradition, and a conscientious survivor of a number of serious illnesses, conditions, and injuries.  Life has dealt me a curious set of circumstances, continuously! And my nature is to discover gems at the bottom of every challenge. I utilize these gems to live a more centered and purposeful life. If you are reading this, you are likely aware that I share my lessons, and the lessons of others, with folks because I remember how rare to easily find solutions.

Since I arrived at my current residence, there has been little time for peaceful rest because the fact that this family matriarch is alive is nothing short of a miracle. The house was a tumble due to her diminishing vision and motor skills; plus, typical in our so-called modern society, the house was loaded with useless gadgets that became either: directly dangerous once vision and strength left, or indirectly dangerous being underfoot collecting dust and dust’s companions of bacteria, fungi, mites et al. Over time, a house requires maintenance, which left undone, builds into bigger redo projects. This clear work-to-do, on top of her physical condition continuing to play havoc unpredictably each day, and you have the makings of a full time job. Stir in the natural emotional concerns of going through this kind of challenge for a 92 year old. And, of course, throw in all the daily paperwork and accounting of living in a modern world that not only requires vision but also begs alert and organized attention unworried by the stress of one’s body, oh-so-slowly, falling to pieces.

My subject keeps saying, “How do you think I made it 92 years?” when confronted with more change. Many changes to her home and lifestyle are very necessary. At first, I agreed that she had done well to get so far along. Over time, refreshing my knowledge base with the current research findings and conclusions, I began to ponder the picture from a bigger view (see References below). Thoughts like, how did she make 92 years in such a state?! How is she still walking? Finding a new surprise in some forgotten task or left undone chore, playing out all that could have befallen her had help not arrived; I began to understand that her longevity has little to do with her lifelong lifestyle choices.

In 2015, living 92 years means living through the rise and fall of pharmaceutical fads. For example, in the 1960s barbituates and anxiolytics became popular and touted as safe. Hypnotics and sedatives made a big wave to the delight of the newly fast-paced baby boomers…who needs to culture sleep? …just take a sleeping pill, magic! Anxious or stressed? …there’s a pill for that, too! Who needs to contemplate their lifestyle choices? …modern medicine has a magic pill for everything. “Just keep on trucking…” one of the many silly sayings of the time that encouraged pushing the limits of one’s physical boundaries. Today, research reveals that long term use of hypnotics not only reduces one’s innate ability to induce sleep…ever again, but in time leads to dementia (see References below). Maybe what I should say to my children is what comes to mind, in reaction to the thought of spending the last few decades of my inherited long life genetics….. “If I am going to be alive in this body, I would at least like to be capable of enjoying it! I would at least like to be cognizant that I am alive!! And I would really be happy to not require my offspring having to take time out of their life plans to take care of my every physical need…. I would want to be capable of autonomy.”

How to get to that high reaching goal comes back to where I always land with every life challenge: conscious lifestyle choices (see Resources below). Recognizing the effect, long and short term, of the many options in this current world, and carefully crafting a personal balance, is an ongoing lifestyle decision for me. The current experience now serves as even more weight in this center stage for self-education and conscientious practice/experimentation/play with what works for my body. Each one of us is a unique combination of genetics, environment, experiences, and character. There are no pat answers to a given diagnosis or condition or personal crisis. But we can start with renewing our goal to pursue happiness consciously and follow that lead to discover our unique form of balance.


Resources – Try these options or similar to prepare for your own aging

  • A great resource for the latest practices based on research written for the “patient on the beat/street”…You. One of the best gifts of this website is a Cognitive Function Test that the site stores for you and reminds you to retake annually. This is one of my favorite sites for updating my patients, friends, and loved ones.
  • “Do you want to add years to your life? Or life to your years?” asks the American Heart Association astutely. The one page link :  provides a quick look at the simplicity and benefits of adding ten minute exercise breaks to your daily routine to dramatically improve the quality of your years!
  • Another idea in the non-pharmacological (and therefore, simpler) category are widening your alternatives. Yoga is a gentle no pressure method gaining more popularity even among conventional medicine advocates. In this link: I have copied a recent formal study that the International Journal of Yoga shared on “Exploring the therapeutic effects of yoga and its ability to increase quality of life” (the study review is not very long). If you have not tried yoga and/or you believe it is for the graceful or otherwise limber folk only, think again. Yoga has always been for every body type.
  • Everything truly is linked…Not to harp on that now notorious topic: obesity, yet those few extra pounds you are carrying will have a similar type of wear-n-tear on your body’s ability to cope with old age.  Try these ideas to get your engines "on" again ... the Obesity Action Coalition offeres free education and resources - ; Strategies to Overcome and Prevent Obesity -  Remember too, please, that healthy habits remain steady when encouraged and supported from a young age; these articles will give you some helpful tips for doing the best to prevent obesity in your children: & 
  • Stress and sleep, the connection is obvious, one impacts the other round and round. The websites and the reams of patient fact sheets available on how to get a better night’s sleep sound pretty much the same. This link from Harvard Health goes a touch deeper in explaining the whys and wherefores of supporting and engendering better quality sleep: And from the same Harvard Health website, here are self-help tips to master your worry tendencies:
  • Look into any stress reduction therapies to gift yourself, such as one or several of the many types of massage therapies; enjoy a pet - dog, cat, bird, whatever gives you a lift; relax with or get up and dance your heat out to music, live or recorded; just pausing to read a paragraph of your favorite novel or any passtime reading you prefer has been shown to reduce the production of adrenaline! Get the idea? take care of your smiles, hugs, and special moments...your way.



Billioti de Gage, S., Begaud, B., Bazin, F., Verdoux, H., Dartigues, J., Perez, K., Kurth, T. & Pariente, A. (2012). Benzodiazepine use and risk of dementia: prospective population based study, from British Medical Journal, 345. Retrieved from:

Chen P-L., Lee W-J., Sun W-Z., Oyang Y-J., Fuh J-L. (2012). Risk of dementia in patients with insomnia and long-term use of hypnotics: A population-based retrospective cohort study from PLoS ONE 7(11): e49113. Retrieved from:

Crimmins E., Preston S., Cohen B., (2011). Explaining Divergent Levels of Longevity in High-Income Countries from National Research Council (US) Panel on Understanding Divergent Trends in Longevity in High-Income Countries. Retrieved from the National Institute of Health (NIH) journal site at: 

Fergeson, J.M. (2001). SSRI antidepressant medications: Adverse effects and tolerability, from Journal of Clinical Psychiatry 3(1), 22-27. Retrieved from:

Gomez, M. ( 2014). Health warning about medications and Alzheimer’s disease, video from CBS New York. Retrieved from:

McMillan, J.M., Aitkin, E.A. & Holroyd-Leduc, J.M. (2013). Management of insomnia and long-term use of sedative-hypnotic drugs in older patients, from Canadian Medical Association Journal 185(17). Retrieved from:

Mehdi, T. (2012). Benzodiazepines revisited, from British Journal of Medical Practitioners 5(1), 501. Retrieved from:

Merz, B. (2014). Benzodiazepine use may raise risk of Alzheimer’s disease, from the Harvard Health Publications’ Harvard Health Blog at:


[More to follow on this article...there are many more resources and even more references! but perhaps an additional blog or two will suffice. Please contact me with questions you would love to discuss.]

Posted on March 19, 2015 and filed under janet's writing, Research studies, resources.

- One Billion Rising Revolution

- One Billion Rising Revolution.

Guess what I am talking about again?One Billion Rising!

Get Up! Stand Up for Ending Violence Against Women! Dance and Sing and Celebrate our right to joy and self-empowerment... to speak of our right and to use the fullness of our power in speaking. Please check out the site and watch the top video and any/all the videos on the site. The music and the beautiful faces telling their story is inspiring and promising...joyful truly.

One Billion Rising was the biggest mass action to end violence against women in human history.

The campaign began as a call to action based on the staggering statistic that 1 in 3 women on the planet will be beaten or raped during her lifetime.

With the world population at 7 billion, this adds up to more than one billion women and girls.

~One Billion Rising for justice. Join the world in rising up.

Posted on November 9, 2014 and filed under discussions, information, janet's writing, mission statements, resources, visions.

Six Simple Numbers photo-1-Version-5As Obama implores, we need to stop Ebola at its source in order to truly end this dangerous threat.


I will share a video story at the bottom of this post to illustrate the difference between Nigeria and Liberia as far as potential to eradicate the deadly Ebola virus.


This very brief article, Six Surprising Numbers, states plainly some very simple needs that would not even take that many of us to help fulfill the desperate situation in Liberia... for, my friends, they have almost nothing with which to fight this disease!

Six numbers....six things to give to keep not just strangers in a strange land keep your loved ones safe too.  


Please also open this additional link [ ] to scroll down for the video of BBC's Gabriel Gatehouse traveling with a Liberian ambulance crew picking up Ebola victims. The article is titled Ebola Outbreak: Cases pass 10,000 WHO reports. But the video...scroll down to the fourth picture you see and click the arrow to open the a live-wire experience riding with the ambulance crew and visiting the only Ebola doctor in Liberia. Nothing can more plainly describe the desperate situation than the actual images of what is happening right now.


If you cannot bear to watch...please listen to it. Then you will understand why I am sharing the very simple list above of just six things we can contribute to help Liberia stop the rapid onslaught of Ebola within their borders.


Posted on October 25, 2014 and filed under information, janet's writing, mission statements, resources, visions.

Diagnosis: P.A.D. Now What? Progression of the Disease

 PAD: Progression of the Disease


Save your arteries, save your life.

Your health care provider warns you that your body is showing signs of Peripheral Artery Disease. The name sounds complicated, so naturally you want to understand better what is happening in your body and why. Peripheral Artery Disease, or PAD for short, is a catch-all name for conditions that damage your arteries. Weakening artery walls, and plaque trying to repair the artery walls, disrupt the easy flow of blood through the artery vessels. Caught early, progression of PAD can be controlled.

Most often, atherosclerosis is what people, even your medical provider, are talking about when they say PAD or peripheral artery disease. But the name PAD actually means any of the conditions that can afflict the arteries. So listen and ask questions to understand which type of PAD you have. In this article, I address atherosclerosis since this is what many people come to me with questions about. And I am also discussing atherosclerosis because some dear friends and associates of mine have learned their thickening arteries are threatening their well-being.

Later, I will follow up this article with more on other types of peripheral artery disease.

Quiet Signs of PAD

Your provider’s diagnosis of PAD may have come as a surprise because you feel fine, no unusual symptoms. Maybe you feel a little bit of achiness, tightness or heaviness in your legs climbing the stairs, maybe some occasional numbness in your toes or fingers, or maybe some cramping in your legs or buttocks. Rest improves the discomfort and those crampy muscles can mean many things, but these signs can also indicate poor circulation. With PAD, poor circulation results in less blood reaching the muscles during exercise. Think of how blood brings life and warmth to all parts of your body, then you will understand how poor nail and hair growth is also a sign of PAD. Other possible changes include sores on your feet that heal slowly, cold feet especially if one is colder than the other and the corresponding pulse is weak too.

How PAD Happens

Plaque build-up along the artery walls, atherosclerosis, is the most common cause of PAD. Plaque occurs as your body tries to heal damage to the lining of your arteries. For example, high blood pressure from smoking tears at the lining of vessels. Plaque tries to cover the damage. High sugar levels in your body, from diabetes and insulin resistance, damage the lining of blood vessels too. Eating the wrong kinds of fat, which alters cholesterol levels, creates more plaque-building material in your vessels. Since more of these conditions are seen as we age, old age is a risk factor. If you or a close family member have had a stroke, you are at risk for PAD. Smoking, diabetes, obesity, sedentary lifestyle and heart conditions all have ways of weakening the artery walls.

PAD Keeps Progressing

If the causes of PAD do not make it obvious why your provider is concerned about your peripheral artery disease, here is a short list of what conditions and discomforts could be in your future unless you take steps now to redirect your body. Having PAD increases the chances you will experience other cardiovascular diseases such as: heart attack, stroke, mini stroke and other threatening heart complications. Once plaque lines an artery wall, more plaque is attracted, eventually making less room for blood to flow through the artery. Clots from the plaque can break away and suddenly jam a heart or brain artery. The symptoms of PAD are uncomfortable and painful but the long term effects are dangerous to your longevity.

Save Your Life

Over time, the effects of poor circulation add up. But you can take steps to slow down PAD and possibly halt its continued ravages to your arteries. You must have a provider to oversee your lifestyle changes, because the provider recognizes and teaches you to recognize the danger signs, helping develop a safe plan back to health. Learn the red flags right away: severe pain in your leg; infections that worsen despite care; loss of feeling in one or both feet; and know the signs of stroke and heart attack. There are surgical repairs for the worst case scenarios or, better yet, get help now to stop smoking and to alter your eating choices in a wise and safe manner. And get more active again to avoid weight gain contributing to plaque build-up and to improve circulation to the areas of your body where bloodflow has been limited by PAD.


As always, there are nutritional changes you can make to ease up some of the load, plaque build-up, your arteries are taking. One of the worst additions to our modern diet that people do not even realize they are eating is sugar in its many forms with its many, many names. Sugar, especially the new forms of sweetener via high fructose corn syrup and its numerous derivations, are added to nearly every pre-made and/or processed food you purchase in our modern nation. Sugar ravishes your body in countless insidious ways. Please review my previous ongoing discussions/articles regarding what has become common knowledge today among providers keeping up with the latest research on nutrition and on research of the effects of modern food additives.

For an example, if you are still choosing the low fat products, you are consuming sugar in far greater than balanced proportions. How can this be so? Besides going back and rereading my articles and the links to the research that I have previously provided, you can contemplate how money is the bottom line when it comes to selling. So what makes you choose a food? Taste figures in there near the top, doesn't it? When naturally occurring whole fat is removed from a dairy food, the feel-good and taste are altered. To compensate, the big food companies early on recognized a bit-o-sugar makes the medicine go down. Today, in order to keep consumers from noticing they are buying sugar, chemical names and new brand names are given to the various sugars added to foods for flavor.

So heads up! if you have PAD, you need to cut the sugar out of your diet everywhere you can sniff it out! This is a good start. In subsequent articles, I will continue to expose the unsuspected sources of sugar in commonly chosen foods in affluent, wealthy, and developed nations. In subsequent articles on PAD, I will also discuss other ways you can alter your lifestyle to help you win the race against this mysterious killer.

Key Concepts

  • peripheral artery disease
  • atherosclerosis
  • P.A.D.
  • vascular disease


Royalty-free image

Resources (Further Reading)

Related Posts on the Lifestyle Modification Support website:

These are just articles and reviews written by Janet Still MSN FNP. There are also many links on this website with articles by others on the same topic of how to become more aware of what is really going on with your eating habits and what to stay abreast of in the current food industry trends and research on the effects of current food industry practices.

Author Bio

Family Nurse Practitioner Janet Still began writing and sharing fiction and poetry in her early years as a pre-med student. Still expanded her published writing to non-fiction after earning her Masters of Science in nursing in 2007. She is a contributor to academic health forums and blogs and the primary writer on the Lifestyle Modification Support blog.

Posted on May 22, 2014 and filed under discussions, information, janet's writing, Research studies.

Distinction: What Actually IS Health?

Define Health for yourself.  married! 020 Yes, we can read the dictionary's definition or we can read up the latest media versions of what is health. A dictionary definition is dry, sterile, at best and only represents a retrospective review of usage of the language. The media is generally a mouthpiece for various commercial interests. This leaves the individual to either be a victim to the purity (or imperfection) of others' motives or to recognize that, ultimately, one makes a decision daily on how to maintain health. What more accurate way to know what health is than self-investigation?


This article could begin by investigating other ideas  and concepts of what is health; yet how close does that take the reader, the individual, towards a useful decision-making technique? As a web content writer, I can tell you that when publishing for broad interest groups, sources, and/or interests, websites have to consider lawsuits and government regulations and standards based upon laws made from information agreed upon by many voices in related fields. Since some interests can effect a greater influence by affluence, do the final laws on the books actually represent what is the highest standard possible? or simply the least contentious by those with the power to object successfully?

So, to self investigate takes on a private focus utilizing what information is available but also, and this is the more astute point, self investigation must utilize personal experiences as one's proving ground. [In even making this point, there are political and potential legal ramifications. Such is the state of life in this modern world that individuals cannot make an action, a statement, without, often very quickly, realizing the effect immediately.] When the population has just enough elbow room to sit one to a chair, the din is difficult to ignore. The din I refer to in this instance is everyone's loud concerns that everyone else, not themselves individually, be responsible for their actions....that everyone else make sure they do not step on "my toes" so to speak. Thus, we have become not only hugely litigious but overburdened by an astounding number of laws governing our behavior. So I am specifically stating that whatever I write, whatever you choose, we all must decide for ourselves whether we are going to step up and be accountable for ourselves in any decision we make. I assume that if you are reading this that you have made a personal and private decision to investigate.

In health matters, self investigation begins by stopping for however brief a moment, literally or rhetorically, to subjectively review every action you take through your day and its potential impact on your health. Begin with you first. We cannot fix another if we have not even figured out in what way we have or do not have a healthy homeostasis.


Posted on April 4, 2014 and filed under janet's writing.

Dr Susan Pacheco - Another Voice

beautiful beach ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Dr Susan Pacheco, a Pediatrician who has committed herself to working an even longer stretch of "the road" for her children by speaking up about an often forgotten piece of the climate change concern.... that of the health challenges documented, researched and validated as the result of  increasing environmental toxicity, and unaddressed by most "debaters" in this crisis. This is a touchy issue because who wants to say they support the profit of oil and other carbon-based products over the health and well being of innocent children? Yet to even write that bit about the debate over this crisis brings up yet another matter that Dr Susan Pacheco's lovely, intelligent and kind video touches quietly without words: that the argument is for argument's sake. Is it not? Else why argue the point, literally the gunpoint, staring one in the face? Things are a'changing here on this precious planet with seven million and counting humans pushing out the other species and spilling over our refuse into the environment in so many ways. What is there to argue with common sense that the fruitflies in the gel medium test tube are crowding one another so much that they have reached the height of their lifespan and population bell curve. Now the down swing of the bell curve begins. The weakest die off first. The question is: because we are sentient beings, could we make moves to alter the course? Could we create a self-sustainable environment? The question is not do we know how to create this however. The question really is: will we?

Please enjoy this link to Dr Susan Pacheco's brief but elegantly spoken and evocatively imaged video. 

Posted on January 29, 2014 and filed under discussions, information, janet's writing, mission statements, visions.

Will You Dance This Year?

Will you dance with us this year?

One Billion Rising

Last year on February 14, 2013, one billion people danced in 207 countries.... Yes, in 207 different countries, a wave of strength and courage empowered by universal love and the willingness to act to know, to do what is right and before one, to speak, laugh, cry, sing and to dance...a wave rose, swelled and swept across the globe in our hearts, minds, soul. This attached video (the One Billion Rising underlined above this paragraph) premiered at Sundance Film Festival January 19. The video is only nine minutes short chock full of rich action when we all danced around the world as One last year.


What is One Billion Rising? In the words of our organization, One Billion Rising is women and their friends, family, lovers and children stopping whatever they are doing and rising to dance in the name of ending violence everywhere NOW.  Vday or February 14 is our day of joy and Love. This is a rising up for justice in the form of calling out the act of violence going on behind doors and in broad daylight around the world daily. By dancing, we speak the unspoken yet loudly heard cry of pain of one billion abused and raped, unanswered by our seven billion in number family of humans. And we dance because this is our expression of freedom to speak and to live life without oppression by violence. Please follow the link to the One Billion Rising page and find out more about what is being done this year in your communities and around the world... and I sincerely invite you to join us in this beautiful full and inspired dance of freedom!


From please read some of the details about the strike, rise and dance for V-day this year.









Go to the website to learn how to participate in One Billion Rising this year on February 14. Lets end violence against women and girls Now, forever. Lets be the co-creators of a Golden Age where all are free to dance without fear or intimidation.

Wherever you are, it begins now.




Posted on January 21, 2014 and filed under discussions, information, janet's writing, mission statements, visions.

Your Arthritis Wants Yoga

Your Arthritis Wants Yoga

bow pencil-paint


“Yoga? For arthritis?” My 40-something friend rolls her eyes and shakes her head, “You must be crazy. How can I twist my body like a pretzel when I cannot bend over?”



What is new about encouraging yoga for arthritis? More research! to back up the benefits of mild to moderate exercise for arthritis, including research specifically using yoga. The research enhances what yoga enthusiasts have been saying for decades: yoga provides many benefits specific to arthritis without alarming physical high jinks and manipulations.


What is important to know about yoga for arthritis? Yoga styles vary; some are well-suited to arthritis, others not so much. Yoga postures are specific to parts and regions of your body; begin with an educated instructor to choose the safest postures for your particular arthritis. Yoga strengthens muscles, thereby supporting joints for a longer joint life, more overall stability in daily activities, and less pain. Yoga provides more than exercise; yoga improves your lungs’ capacity, yoga enables deep relaxation, and yoga increases mental clarity.


How does yoga accomplish all this? Some yoga postures strengthen the large muscle groups that are used for the position, which then benefits the corresponding joint by lessening duress on the joint. Yoga increases range of motion, which gives you more room to work with before reaching your joint’s stress point. The combination of deep conscious breathing combined with focus on the body during the positioning for each posture has been shown to increase endorphins. Endorphins are those “feel good” hormones that up your mood and sense of well-being, decreasing the sensation of pain. As with all exercise, the movement and breathing causes your body’s blood, filled with needed oxygen, endorphins, and nutrients, to move more effectively into your muscles.


What do you need to know to have a positive experience with yoga and to experience improvement in your pain levels? Research shows that each individual discovers their unique range within any exercise as far as stretch and endurance. As with all exercise types, begin slowly and gradually increase how much you are doing as your strength for the practice improves. An experienced and specifically trained instructor will know which postures are safe and how far to go with the position. So choosing a qualified instructor insures you have the best support for learning your range. Some classes are for yoga performed in a chair! So whether you are limited to a chair or if you need to incorporate exercise into a sedentary work situation, you have options to enhance your personal experience with yoga. Choose from Hatha Yoga schools and teachers for yoga best suited to Arthritis. Some Hatha Yogas which work well with Arthritis are Iyengar, Integral, Ansura, and Kripalu. See the Resources list at the end of this asticle for more links to schools of yoga.


The “always” list: Talk to your Arthritis Provider before beginning the first yoga class to receive specific instructions about any restrictions or limitations to share with the instructor. Discuss with the Instructor their experience with Arthritis students as well as your doctor’s recommendations for your specific condition. Choose a beginners class and progress slowly even if you feel good during the class. The saying “no pain, no gain” does NOT apply to you or to yoga. Pain means slow down, pull back some on the stretch, and/or take a break.



The Yoga Alliance is a great resource to finding certified yoga instructors. The site provides a directory and also provides links to more information on yoga education.

The Yoga Journal is available at many stores including your grocery store. Inspiring and educational articles keep you updated on the latest research related to yoga for many conditions including Arthritis.

The Arthritis Foundation has a DVD especially for those with Arthritis that shows yoga postures specifically for various types of typical Arthritis conditions. The DVD is named Arthritis Friendly Yoga and can be found at:



Ehrlich, S. (2012). Complementary and alternative medicine guide: Rheumatoid Arthritis; University of Maryland Medical Center Health Information and Medical Reference Guide. Retrieved from:

Gothe, N., Pontefex, M., Hillman C., and McAuley E. (2013). The Acute Effects of Yoga on Executive Function. Journal of Physical Activity & Health 10(4):488-95.

Haaz, S. (2009). Yoga for Arthritis; The John Hopkins Arthritis Center website at:

Sharma, M. (2013). Yoga as an alternative and complementary approach for Arthritis:

A systematic review; Journal of Evidence-Based Complementary & Alternative Medicine 18 (3).

Posted on October 20, 2013 and filed under information, janet's writing, Research studies, resources.

Communication … Simple, Right?

Janet Still FNP

Lifestyle Modification Support


Communication … Simple, Right?


If communication is as simple as speaking one’s mind, why all the fuss about misunderstandings? Someone else’s problem, some of you may answer; others of you are too busy to answer as you are in the midst of an issue in your life to address and are uncertain where to turn for answers….with no time to talk or, more importantly, listen to another perspective. And I do not want to leave out those of you that are well aware of how complex simply talking with another can be, unless one is paying close attention to the many verbal and nonverbal signals the speaker is giving. This has been a week rife with examples of how much more complex communication has become in our modern world of expanded communication opportunities via computer technology, and because of immensely advanced data, knowledge, and potential directions that the continuously advancing technologies offers us.

tech icon

Reading this article may offer you a nudge as to how to redirect confrontation in a healthy and mutually beneficial manner. Reading this article may awaken you to recognizing your point of view is possibly exactly the same as the others in your “situation” but how you are choosing to communicate your viewpoint is the cause of your perceived problem. And hopefully, whether you have been told this a proverbial one hundred times or not, this article may enlighten you to the fact that others actually cannot read your mind nor can you accurately read their minds either!


From Congress’s ongoing verbal posturing solving nothing apparently this week (no budget, no government) to the multitudes of battles verbal to physical in our world, communication is a clear issue. Language barriers are an obvious impediment in accurate transference of ideas, desires, hopes, and problems. Even in those speaking the same language, however, barriers related to language abound. Obvious difficulties arise from different desired outcomes in the exchange of ideas. This article is about when we either ostensibly want a shared outcome like good or better health, or when we sincerely know we must create an agreeable compromise, but somehow come out of our conversations feeling further from our goals. Have you ever left your doctor’s appointment feeling more clueless that when you went in? Why does that happen? Sometimes there isn’t even new information; you and the doctor just seemed to be speaking from two entirely different worlds. He or she is in a hurry because the fella in the next room is plainly in a desperate way by the sound of his incessant coughing, you give up and never even ask the questions you intended because you are trying to digest what the expert just shared … before the expert smilingly dashed out the door.

Young, smiling female doctor in a white coat.

I have been that expert smilingly dashing out the door. Because I hated the situation, I have given much thought to how to prevent the repeat performance. I saw by your facial expression that you felt clueless or I heard your exasperated stifled sigh, but when I asked if you understood what we talked about, you said, yes. This week I once again became aware that age-old adage that communication is a two way street or that “it takes two to tango” needs a more thorough review. My work as a virtual consultant-advocate is about helping others to communicate more successfully with their healthcare team. I act as your “Ghost-writer” case manager sometimes when you come to me with a healthcare issue. Most of the time, my clients complain that their provider does not hear them, understand them, or in some manner disagrees with the patient goals. We go over your medical records, history of symptoms and treatments, what worked and what did not work from your viewpoint, and make a game plan for you to share with your primary provider. Great first step.


In experience, communication faux pas occur even with a great plan. Often the actual source of the communication problem turns out to be the patient did not understand their provider’s wording. Medical jargon, local dialect (lingo), interruptions, a moment of processing one idea causing the patient to simply not be listening when the important detail was spoken, faulty hearing related to illness or sounds in the clinic … all are possible reasons for the omission in understanding. I share this because while as experts and providers, we are responsible for effective communication with our patients, we do not have control of every aspect of every situation. At the same time, your health and wellbeing may be in danger. Yes, I can help you, the provider says, but not if the two of you are not clearly tracking on every detail of the conversation.

kapowie copy

If you are making a decision not to follow your provider’s expertise, you must communicate that to the provider right away. Your provider cannot be held accountable if you do not follow his or her medical advice and your health fails. Some folks fear the confrontation. I admit I have witnessed providers becoming overly attached to patient’s decisions. To my own surprise, I, too, have been very anxious for my patients when they disagreed with the treatment options. Often the problem here is two-fold: the patient has waited too long to honestly express their feelings regarding the diagnosis and treatment; and/or the provider has not adequately communicated the whole picture so that the patient can comprehend all the possible risks and benefits. But whatever the reason for the impasse`, please be aware that ultimately your provider has an ethical and legal obligation to direct you to alternative care and/or treatment options. SO PLEASE speak up when you are disturbed or upset by the interaction. Do not leave if you intend to not follow the treatment plan until you set up an alternate plan to address your situation.

musical note

Here are some tips for you regarding communication with your healthcare expert, in descending order of urgency, start with the last tip and move back up this list:

~When your provider or the clinic’s staff or someone sufficiently trained in your symptoms says to go to the ER when you are experiencing certain types of symptoms, ….GO TO THE ER. Do not collect $200, do not wait anxiously for very long to receive a call back from the provider’s office. Only call your friend or your mother to take you to the ER if you have called ER and they said it is okay to do so. Otherwise call 911.

~Before you call your provider’s office with disturbing, strange, painful, and/or scary symptoms, first give a few minutes to thinking how to get the unusual nature of your symptoms across in very few words to the receptionist. The receptionist is not a trained medical expert. Hopefully she has received and understood training for certain keywords to recognize an urgent situation. Do not count on that. What is scary about your symptoms? Did you listen or take home an info sheet on what to look for to call the doctor urgently? If you did, let me give you a big cheer right now! Those are the words to express specifically and clearly to the receptionist. If not, think how you would explain this to a friend or neighbor that you would ask for help so that they understood how the seriousness of your question. Here is a hint: if just trying to get to the file cabinet for that info sheet or walking to the neighbor’s door may have you gasping for breath, that is a serious symptom, shortness of breath. Others are: feeling faint or blacking out, extreme pain, dark colours in your urine, feces, or other body fluids (this is blood usually) . . . and anything that prevents normal daily life activity.

~Do not listen to people who have no medical training about life threatening situations. That sounds very oppositional or negative but I am not saying they do not have experiences or wisdom to share. Sure, listen to them, but when it comes to decision-making, surely you want to have all the information about your specific situation to hand in order to make the best decision for you, your continuing health. To this end, request from the clinic staff, or your provider directly, info sheets for emergency situations as well as for support groups, websites with reliable sources and resources. Ask whether a national organization exists for your condition so that you can educate yourself for all possible situations ahead of their happening and to prevent complicated situations from ever arising. If your clinic does not have this information or is not willing to assist you with this type of request, something is wrong. Find out why and look for more answers wherever you can.

~Express understanding when requesting more information; listen to their answers and make note of the information for filing away; make note as well of any promises for future resources and return to retrieve the information because you are in charge of your health ultimately; make it clear to your provider and the clinic staff that you are an active member of the healthcare team on your case. A good healthcare team will be happy to know you are on the ball. When you have questions, write them down as soon as possible to ask. Ask the clinic and provider their preferred method of receiving requests and concerns and always use their preferred method first, making note if they fail to reply by their stated method. Let them know where they let you down, because a strong healthcare team wants to know these issues in order to improve. Get clear with your provider your desired outcome for your healthcare condition and listen to hear your provider agree or disagree. If your provider has a different outcome in mind, ask for reasons and whether a compromise is possible.

~Finally, what should be stated first, but I always state last for emphasis: always begin all your written or spoken questions, requests, discussions with … direct eye contact, a kind expression such as a smile, and an honest statement of something observed about the person that you can commend or compliment. I know you may be feeling horrible. You are sick after all. What about the staff? They face ill people all day in grumpy grouchy unpredictable moods… ALL day. The job is often so stressful that staffing shortages are a common theme, so that harried receptionist may be having to pull overtime after calling desperately to find childcare and/or may have been doing the work of two all day because their coworker called in ill and so forth.

Night dance

Communication is a two way street, which means that you also must give a little to receive, for the tango to come off sensationally. How hard is a simple kindness to another? A question folks often ask me when they feel they have been ignored. What about turn-about? Start on the right foot, with respect, and then follow verbal respect up with actually giving respect in your actions. Listen to others with sufficient patience to learn if the solution you need is already a given or if communication seems to be failing. This foot-forward approach nearly always saves time and effort. Who would not go out of their way to help someone who has treated them with patient kindness? Maybe you.

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Additional reading, resources, references:

Fong Ha, J. and Longnecker, N. (2010). Doctor-Patient communication: A review; The Ochsner Journal (10) 1; p 38-43.

Haftel, Lypson, and Page (2008). Patient-Doctor communication: The fundamental skill of medical practice. Retrieved from:

Ludwig, M. (2008). Physician – Patient relationship; Ethics In Medicine: University of Washington School of Medicine. Retrieved from:  

National Institute of Health (NIH) (2013). Talking to your doctor: Resources from NIH. Retrieved from:

White, C., Moyer, C., Stern, D., and Katz, S. (2004). A content analysis of e-mail communication between patients and their providers: Patients get the message; Journal American Medicine Informatics Association (11); p 260-267.

Thanks to Microsoft royalty-free clipart for the icons, the doctor and the dancers photo.


Posted on October 4, 2013 and filed under discussions, information, janet's writing.

High Blood Sugar in Diabetes 2: What To Do?

Janet Still FNP

Lifestyle Modification Support


High Blood Sugar in Diabetes 2: What To Do?

You have a diagnosis of Diabetes type 2 and are doing a great job taking your new medications on time and paying attention to your diet to prevent high blood sugar. Today is, perhaps, a different day from your routine though; before you know it, time has run away from you, and you do not feel so well. Could this be your blood sugar running high (hyperglycemia)?
Classic signs that your blood sugar is running higher than is safe in Diabetes type 2 are emptying your bladder more often than is typical and feeling much thirstier. These two symptoms can fool the distracted mind since they seem to go hand in hand. Just because you are drinking more, you expect to empty your bladder more. Yet when you have Diabetes 2, you now are the captain of your body with full duties to respond to signs from your body that the ship may be experiencing a violation to the integrity of its hull. So, make a mental note: any signs of change in your routine bodily behavior could be a distress signal from your body. Fatigue, blurred vision, headache are also signs for increasing blood sugar levels. Start issuing orders to self and, if necessary, your healthcare team.
IMG_1248Before I go any further, if you have not been advised, or have not taken the forthcoming instruction to heart yet, your blood sugar running high for long periods of your day is a recipe for disaster. This fact can be a struggle to accept until the individual recognizes that high blood sugar is not merely something to worry about far off in the future, but if your body is unable to keep your blood sugar levels from rising right now, you are potentially heading for a diabetic coma…right now, today!
For those of you that are seeking a way to turn around this character in your life called Diabetes 2, this brief article is to provide you some resources and information that you can implement quickly, six steps for your immediate hyperglycemic situation. Steps that can be used to prevent hyperglycemia over the long term are mentioned at the end of the article. Taking charge of your Diabetes 2 or even the pre-diabetes condition is as simple as educating yourself and implementing lifestyle changes that you can truly live with…figuratively, and literally. The information in this article is not meant to replace instructions from your Diabetes provider and instructors. This information is meant to help you follow your Diabetes 2 instructions with more ease, and hopefully, with more joy.
IMG_1288Life is famous for changing the game up, as the saying goes. This goes double for someone with Diabetes 2. Staying with our first example, let’s say you are able to check your blood sugar and learn it is above 200. You recall your Diabetes 2 instructors telling you that above 180 is moving into dangerous levels and that means your body does not have enough insulin. What can you do right now to move into a safer blood sugar level?
Wait! How the heck did my blood sugar go up? I did everything right this morning. I took my medications on time, ate a healthy breakfast, and even got in some calisthenics before my morning shower.
First of all, if you do not already know, many particular activities or situations can cause your blood sugar to rise. Supplies to always have on hand are your glucometer for checking your blood sugar level, a travel ketone urine kit, and extra anti-diabetic medications. Stress is a biggie, which includes stress from being sick, overworked, happy or sad, or simply overly anxious. Why? Increased stress causes your body to release hormones related to the cause of the stress, which in turn elevate the level of glucose in your body. Even people who do not have Diabetes 2 can have hyperglycemia from increased or prolonged stress.
Checking your blood sugar levels when you experience suspicious changes in your body’s routine is a seriously necessary step in addressing hyperglycemia. Returning to our example of a busier and more demanding day than usual being today’s cause of high blood sugar, ditching the worksite to run around the block in your best professional attire may not be appropriate or even possible. More importantly, because your blood sugar may have risen quickly in response to stress, your body may have begun making ketones. Depending on the severity of your stress level today and how high your blood sugar has risen, collecting some urine for your travel ketone test is a smart idea. Exercise is dangerous when your body is producing ketones. If your urine kit tests positive for ketones, call your doctor now for immediate advice. Repeat: call your doctor now for immediate advice. Ketones need to be addressed now.
IMG_1240No ketones? Awesome news! You have caught the body’s signals in time to take charge without calling the doctor’s office. Your Diabetes 2 provider may have already given you instructions for additional amounts of medication to take when your blood sugar has risen. Follow the game plan and keep track of details, maybe jotting some notes on things like: what caused you to check your blood sugar level initially before the scheduled time, whether you get in some exercise after taking the medicine and before checking your blood sugar level again, and how fast the symptoms that annoyed you (thirst, fatigue, headache) change or improve.
About getting in some exercise ….. I have written previously on ideas for including moderate exercise that is enjoyable to you on a more routine basis (see LMS article dated September 2013). Unexpected, undesired! bouts of hyperglycemia are why you want to make a habit of moderate exercise. In pre-diabetes, adding routine moderate exercise and reducing foods that increase blood sugar dramatically can prevent your ever having to take medication for persistent high blood sugar levels. With a Diabetes 2 diagnosis, exercising can prevent the ravaging effects of continued high blood sugar on your body. Besides the short term danger of runaway blood sugar levels causing a diabetic coma, long term uncontrolled hyperglycemia is what causes all the frightening complications of Diabetes 2. Becoming the captain of your body, this proverbial ship, is as simple as learning what exactly is causing what to happen in your body, and changing up the orders to yourself regarding when to enjoy various activities.
IMG_1234Six steps to taking charge of high blood sugar levels (hyperglycemia) are:
1-      Take notice of changes in your body; and know the signs of rising blood sugar levels;
2-      Carry a glucometer, always, in order to check your blood sugar levels routinely as well as when your body is signaling you that something is off;
3-      Carry a travel urine kit for checking ketones for the unplanned/unexpected blood sugar rise;
4-      Learn exercises that are possible to do in unique circumstances, such as sitting at a desk; and do not eat additional foods, unless instructed to do so, until you re-establish a safe level of blood sugar;
5-      Always be ready and able to contact your Diabetes 2 provider for instructions when ketones are found, and for when your blood sugar level is not going down, even after taking additional medications per instructions;
6-      Follow the game plan created by your Diabetes 2 instructors until your blood sugar level returns to normal.
Discovering your blood sugar level is rising and learning to recognize the signs of blood sugar rising are key elements in preventing serious consequences from hyperglycemia. When life has altered from the routine, be ready to alter your routine Diabetes instructions to make unscheduled checks on blood sugar levels and ketones by having a glucometer and urine ketone kit available. If your body is not producing ketones yet, exercise to use up as much of the additional blood sugar as possible. Learn or create ways to increase exercise for your unique situations, like desk yoga, tai chi while talking on speakerphone, jogging in place between customers, whatever applies to your personal circumstances. Most imperative, know your Diabetes provider’s instructions for elevated blood sugar levels and act on them without procrastination. Your body relies on you to stay afloat through life’s changes. Be the smart captain of your ship by seeking and creating simple ways to remember your healthcare plan.
Smooth sailing, mates!
Resources and References:
American Diabetes Association; 2013. Fitness; American Diabetes Association: Food and Fitness. Retrieved from:
American Diabetes Association; 2013. Hyperglycemia (High blood glucose); American Diabetes Association: Prevention. Retrieved from:
American Diabetes Association; 2013. Success story: Sarah Boison; American Diabetes Association: Success Stories. Retrieved from:
Casteneda, C., Layne, J., Munoz-Orians, L., Gordon, P., Walsmith, J., Foldvari, m., Roubenoff, R., Tucker, K., and Nelson, M.; 2002. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes; Diabetes Care 25, 12; 2335-2341.
Center for Disease Control and Prevention CDC; 2011. How much physical activity do adults need?; CDC 24/7: Saving Lives, Protecting People: Physical Activity. Retrieved from:
Mayo Clinic Staff; 2012. Hyperglycemia in diabetes; Diseases and Conditions on Mayo Clinic webpage. Retrieved from:
Nathan, D., Buse, J., Davidson, M., Heine, R., Holman, r., Sherman, R., and Zinman, B.; (2006). Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy - A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes in Diabetes Care 29, 8; 1963-1972.
National Institute of Health NIH; 2013. Get active; National Heart, Lung, and Blood Institute Retrieved from:
van Dijk J, Tummers K, Stehouwer C, Hartgens F, van Loon L.; 2012. Exercise therapy in type 2 diabetes: is daily exercise required to optimize glycemic control? Diabetes Care 35, 5; 948-54.
Posted on September 16, 2013 and filed under discussions, information, janet's writing, Research studies.

Can Exercise Improve Your Diabetes?

Janet Still FNP

Lifestyle Modification Support


Can Exercise Improve Your Diabetes?

Easy answer …yes! But you knew I would say that. And that answer is just not enough, is it? Or for some of you, maybe it is and you are reading this article simply to get to the facts and suggested resources in hopes of finding something you can easily incorporate now into your everyday life. For both camps of readers, the purpose of this article is to briefly lead you to your unique goal of improving your health and your prognosis report.


First, for those of you that are reading with a feeling of angst regarding exercise, I understand that this condition of diabetes has likely already created much more upheaval to your lifestyle than you ever imagined you would have to endure. This article is purposefully brief with a goal of providing you some simple directions you can take today to retake control of your body.


For those of you that have already accepted change is your choice and who are seeking a way to turn around this character in your life called Diabetes, this writing is to provide you some resources and information that you can implement quickly, for your short term goals, and also that can be used to refine your direction over the long term.

joyful childs beach


When your healthcare provider mentions that exercise improves glycemic control, she/he is sharing a key to your taking some of your body back. Plenty of research over the years continues to evaluate the specific details of how physical exercise alters blood sugar levels and reduces the body’s requirement for anti-diabetic medications. Reread that, yes, I said that exercise so changes your blood sugar levels that you will have to take LESS of your diabetes medications. Write that on a piece of paper and tape it to your morning mirror as motivation.


Three days a week, 30 minutes of moderate exercise, this is the repeated consensus of the minimum to reduce blood sugar. If you do not know, the way exercise works is that your muscles use the blood sugar! too, so that means less work on your pancreas and less work for your medication. Sounds good; let’s keep going with the good news….. what does “moderate exercise” mean exactly? My favorite way to define moderate exercise is: activity that allows one to engage comfortably in conversation while doing the activity. Easily one can see many activities one could incorporate into daily life that allow talking. Walking briskly with a friend or with your dog or how about from the far end of the parking lot are simple changes to include this moderate exercise. Playing with the kids or the neighbors’ kids an easy game of catch ball for 15 – 30 minutes and voila` you have just improved your body’s ability to manage its blood sugar level. Using stairs instead of the elevator; add up your time spent with household or office chores like vacuuming, dusting, and tidying at the end of the day; there are many normal activities that you can do with a focus to increasing your time spent moving.


I already do all that, you say. Or some of you say that thinking about it makes you tired. This is your body, your health, your independence, so I am assuming you read this with hopes for something unique to your situation. Taking a class is often a great way to have someone do all the calculating and training for you. Classes and trainers are a great idea to wake up your mind regarding what moderate exercise feels like; how to protect your body from injury so that you can keep exercising and taking back your life; and to just get you moving in a new direction. Choose the activity and teacher with an eye to gradual progression from your level of fitness to a moderate routine. Interview the teachers. Any trainer worth their salt cares about the people in their class and is also a great resource for more appropriate classes for your individual circumstances.


There are some standard resources for everyone regarding exercise and many other health topics, so keep them in mind as a back-up when making decisions about your health plan. The Center for Disease Control and Prevention (CDC) always has brief and current statements available online with links to more detailed resources. The National Institute of Health also keeps abreast of research on health topics and routinely posts simple information. An example of the type of information you can find online is this very short info sheet on how much activity is sufficient for adult health: which outlines specific types of activity to meet the minimum requirements of adult health. The CDC also has a phone line dedicated to providing information at: 800-CDC-INFO (800-232-4636).


N swimYoga gets you moving and gently waking up those unused muscles, which can protect you from injury. Tai Chi is actually considered to be resistance exercise, so adds the benefit of keeping your bones healthy too. Dance classes with a focus on fun, movement, and progressive strength building are a happy way to keep your muscles using up blood sugar while having a good time meeting new folks. If a swimming pool is available to you, aqua aerobics is easy on the sense of working hard because water lessens the gravity while absorbing heat. And always walking is the simplest, most flexible, and very affordable exercise for changing your lifestyle into something you can still call your own. 


Call up your local hospital or your provider’s clinic to ask for recommended exercise groups, trainers, and/or classes. Schools and colleges offer adult education classes all year nowadays and usually include at least a few exercise classes at a reasonable cost to get you connected to your community’s resources. As mentioned before, classes offer the added benefit of meeting others with like goals as well as networking connections in general. Some gyms offer less expensive memberships for attending workout classes only. And just get out and walk….take notice of how you feel before and after the walk. Chances are very good that you will be glad you now have a good reason to get back into using your body…because it plain ‘ole feels good.


Resources and References:

American Diabetes Association; 2013. Fitness; American Diabetes Association: Food and Fitness. Retrieved from:

American Diabetes Association; 2013. Success story: Sarah Boison; American Diabetes Association: Success Stories. Retrieved from:

Casteneda, C., Layne, J., Munoz-Orians, L., Gordon, P., Walsmith, J., Foldvari, m., Roubenoff, R., Tucker, K., and Nelson, M. 2002. A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes; Diabetes Care 25, 12; 2335-2341.

Center for Disease Control and Prevention CDC; 2011. How much physical activity do adults need?; CDC 24/7: Saving Lives, Protecting People: Physical Activity. Retrieved from:

National Institute of Health NIH, 2013. Get active; National Heart, Lung, and Blood Institute Retrieved from:

van Dijk J, Tummers K, Stehouwer C, Hartgens F, van Loon L.; 2012. Exercise therapy in type 2 diabetes: is daily exercise required to optimize glycemic control? Diabetes Care 35, 5; 948-54.


Posted on September 5, 2013 and filed under discussions, information, janet's writing, Research studies, resources.

Brain Food; Continuing the dialogue on how to make a healthy brain

Janet's Eye on the Media

"Your brain thrives on fat and cholesterol" and the products that are fat-free are depriving you of needed nutrients. Lifestyle Modification Support (LMS) has been talking about this the past year.... I hope you will consider the information seriously. Look up the references and many many articles addressing this issue.

Here is another book on the topic and the source of that quote above: Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar--Your Brain's Silent Killers by David Perlmutter and Kristin Loberg. Found on at :


O thank heaven for summer!

Some times reading the daily news feeds on health, the scene resembles a battlefield.  There sure seems to be a lot of contenders for the battlefield! Scrutinizing the players more closely with an eye to motives, one could get the impression that the real prize is money .... not providing the most efficient path to whole health. Meanwhile, folks are also making a living providing you with information...well some are. Might I make a suggestion? always read the books and articles remembering what the authors stand to win by promoting their viewpoint. This is no critique on the book above or any information in the news today in particular. I mean this caution honestly.


Patient-centered healthcare planning begins with You educating yourself and making a commitment to directing your care, and life therefore. Another way to say this is: taking the helm of your healthcare direction means being accountable to your awareness and decisions. . . . which includes changing your mind when you learn new data and sift it through your discerning brain.  So I am describing an ongoing process or a "way of life"... an active occupation of being responsible.


To maintain a discerning mind requires a well nurtured brain. A healthy brain mind is the key to enjoying life, the "feeling" of being alive, many tout. Makes sense to me, and even further, my own experience is that when those around me are healthily vital, alert and discerning, and capable of interacting spontaneously in given situations and circumstances, I benefit, the people I care about gain much in expanded awareness, and the ever expanding world grows and evolves in front if us by our own volition. I am stating, (I am certain your discerning mind has caught by now), my motivation for sharing this information, nearly all the information in the Lifestyle Modification Support (LMS) blog. And I am also explaining to you why it is so important  that you care about your brain's health.


beautiful beach A curious observation of healthy vital folks is that they seem to love, thrive on, life, and its challenges. While those that are "tired" and describing they just want to stop thinking or working at the end of the day (some the beginning or middle of their day sadly) appear to censor aspects of life, especially anything challenging.  Why, this one wonders. Some of you are answering, well that is normal, isn't it? We work all day; we get tired; and we go home to eat, drink, and sleep. IS this normal? Whose normal? When did this become normal? What else was going on historically when this picture became normal? A few points to contemplate. I am not here to do all of your homework; I am here to stimulate your attention.


If you are too tired to desire the healthy and engaging challenges of life, what can you do to wake up your brain? Should you want more out of your life, how can you make active movements towards creating the aliveness you enjoy? LMS has been sharing references all along this ongoing discussion and its many permutations and we are so happy to continue doing so.  But bottom line today is: please consider that you really are what you eat. With some foods/chemicals, time on the particular element or food must be lived to realize the changes ... both healthy and fatiguing.


To realize a healthy and vital brain, eat the foods that feed your brain; avoid the "foods" that starve the brain or otherwise disable its continued vitality. Pretty simple. Oh, except for knowing what that means literally in what to buy and eat from your market or favorite food server/restaurant. So let's keep up on what is happening in the world of nutritional research today.... (I always ask for and enjoy feedback). I mean real and valid research rather than pseudo-science that has become popular among the biggest "food" (and drug) sellers today. To date, research from around the world continues to reveal that many modern foodlike substances sold in packages as food in your local grocery store do not contain valuable and needed nutrients for your body. The sellers of these foodlike substances even openly state that providing health is not their business, rather making money is their primary incentive (The extraordinary science of addictive junk food, Moss; 2013). What, then, is healthy food? the other part of the question and the only part that matters to me....getting real food for my brain. Another article on why fat-free might as well be called eating cardboard, addictive cardboard truly, cardboard all the same... is Dr AnneMarie Colbin's blog  "Fat-free Food: A Bad Idea at:


Lifestyle Modification Support will continue to add articles on good food for your brain from many sources. Meanwhile, scroll down the front page of LMS to reread the articles shared already on how fat is required for brain cells to function. For a really adorable article, easy to read and understand, on how our brains evolved via fat, read The Human Brain from the Franklin Institute at: . Or read Brain Food: Good Fats Better for Memory on LiveScience at: . For those of you preferring a more scholarly diatribe but brief, check out Dr Gary Wenk's article in Your Brain On Food titled Dietary Fats That Improve Brain Function at: .


I sincerely hope this helps you get started, if you only just catching up to this conversation.

Always, stay awake and alive! and feel free to contact me personally or via this blog to share your thoughts, concepts, questions, or concerns. photo-1-Version-5

I Am,

Janet Still FNP

Posted on August 8, 2013 and filed under discussions, information, janet's writing, Research studies, resources.

Got Skim Milk?: Maybe a Recipe for Obesity and Cancer

Okay, what did I tell you?

I do not exactly appreciate the "I told ya so" comeback; yet, sometimes it is all one can say! Research that is scientifically valid will continue to back these conclusions (in the linked story/article), because the logic is sound as well as the makers of said products have openly admitted that they are not in the BUSINESS of health, they are in the BUSINESS of selling food items. Please go back and read my previous posts, if you are wondering where I am coming up with my viewpoint. And finally, research will validate these findings because, simply, foods in their natural state have evolved alongside of our gastro-intestinal (GI) systems. New foods created in labs for dubious ends, such as profit, will require some time to integrate into our cellular metabolic processes. Let me long did it take for us to adjust to wheat, for example. I use that as my example because some will say that we have not actually finished integrating the use of wheat in our GI systems.

Just checking in. Many more immediate and up to the minute news posts are on the facebook page at:

Keep contacting me with all of your ideas and questions. I enjoy hearing from you.

Posted on July 12, 2013 and filed under discussions, janet's writing, Research studies.