Being Mindful

Dr. Brad Weiner | May 24, 2017

Some of my most insightful conversations with my children occur when I have a captive audience.   Long car rides, cross-country plane flights, or a shared ski lift are just a few examples.    I was recently navigating rush hour traffic in Boston with my second grader in tow when he said, “Dad, do you know how to practice mindfulness?”   I’m not sure whether I was more taken aback that he knew about mindfulness, or that he was thinking about mindfulness while en route to a sporting event.  Maybe he recognized my frustration with the congested roads.

While I was aware of mindfulness, I wasn’t familiar with its practice.  So, like any good parent, I turned the question back around to my son.   “Maybe you could explain it to me.”   He replied, “Mindfulness keeps you in the now.  It helps prevent your mind from wandering off.  It keeps you calm.”

Energized by our conversation and wanting to learn more, I reached out to Rana Chudnofsky, MEd, our mind-body specialist at PersonalMDs.  


Brad:  Rana, how would you describe mindfulness for those not familiar with its practice?

Rana:  Mindfulness is a mental state achieved by focusing one's awareness on the present moment, while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations.  When an individual is practicing mindfulness, that person is focused on simply being in the moment.  Focusing on the present helps one avoid racing thoughts.  This is called the monkey brain, when a person’s mind constantly jumps from thought to thought, similar to a monkey jumping from branch to branch on a tree.  By learning how to be in the moment, a person can get into a more relaxed state.  

Mindfulness is not something you practice for twenty minutes every day.  It is really more of a way of being, a way of conducting oneself in daily life.  It encourages being present in the current moment, focusing on one task at a time.  This can be difficult to achieve because our minds are so complex.


Brad:  Is it safe to say that multitasking is the opposite of mindfulness? 

Rana:  Yes.  If you’re always rushing through life doing many different things, it’s difficult to experience and appreciate what is around you at the present moment.  


Brad:  How does one practice mindfulness?

Rana:  Mindfulness can come naturally, with extraordinary ease, in commonly encountered experiences.   Awareness of the outdoors is one common example.  What does the temperature feel like?  Is there precipitation on your skin?  Do you feel a breeze?  What sound do the trees make as they sway in the wind?     

You can practice mindfulness in any situation.  Golfing is another great example.  When you step onto the golf course, what does the freshly cut grass smell like?  How does the club feel in your hand?  Do you see the contours of the greens?

Today’s modern health clubs make it difficult to practice mindfulness.  Music is playing, televisions are flashing images on their screens.  But even with this commotion, one can be mindful.  How are you positioning your body?  Are your feet evenly balanced on the floor?  What is the pace of your breathing?

Try practicing mindfulness at home.  When speaking with a family member, really be present to what they are saying.  This means no judgment, but an openness to what is being conveyed.

Being mindful is important for musicians and athletes too.  Mindfulness stops the train of racing thoughts.  If the musician is not present in the moment, the music will not sound beautiful.  An athlete whose mind is not focused on the task at hand can have difficulty competing in their sport.

Mindfulness can contribute to healthy nutrition as well.  When eating, do you savor the taste of each bite or do you rush through the meal?  Those who eat more slowly with an awareness of flavors and textures tend to feel more satiated after a meal, compared with those who eat quickly and still feel hungry afterwards.   Have you ever gone to a movie, purchased a bag of popcorn, and eaten the entire contents of the bag only to wonder how in the world did THAT happen?  This is an example of not being mindful.  Life happens, and sometimes the results are a real surprise.


Brad:  Does mindfulness enhance our health?

Rana:  Mindfulness can help many people but not everyone.  Mindfulness is more of an adjunctive therapy.  It may help reduce some physical symptoms of stress, anxiety, and depression, but it does not alleviate all symptoms.  

Sara Lazar, a neuroscientist at Massachusetts General Hospital and Harvard Medical School, was one of the first researchers to take the anecdotal claims about the benefits of mindfulness and meditation and test them in brain scans.  She found that those who practice meditation over the long term have increased amounts of gray matter in the sensory areas of their brains. 

This is logical because when you are mindful, you are paying closer attention to the present moment, to your environment, to your breathing, and to the sounds around you.  It stands to reason that the senses will become enhanced for those who practice mindfulness.


Brad:  Thank you for your time and for teaching us about mindfulness. 

Rana:  It’s my pleasure.


As a friendly reminder, Rana is available by appointment for all members of PersonalMDs who are interested in learning more about mindfulness and other forms of meditation.  If you would like to meet with Rana, feel free to call our office or send an email and we would be happy to schedule a visit. 


Wishing you a relaxing and mindful summer,

Brad Weiner, MD

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

Advanced Care Planning: It's Never Too Early

Dr. Brad Weiner | September 05, 2016

It’s always important to plan ahead for the future.  When we are healthy and active, it’s natural to avoid thinking about what may happen if we were to develop a significant illness or injury.  However, the best time to plan how our affairs will be managed during sickness is during times of good health.  If we become seriously ill, what type of medical care do we wish to receive?  Do we seek heroic measures, comfort care, or something in between?  Who will make these decisions for us should we become incapable of making them ourselves?  Fortunately, we have several tools at our disposal that make it easier to plan for such difficult times.



The MOLST (Medical Orders for Life-Sustaining Treatment) form was implemented statewide in Massachusetts in 2012.  This form was created to help individuals document their goals of care should they develop a significant, life-altering illness.  It is a legal document that guides physicians, family members, and other providers who deliver medical care.

The MOLST form represents an important advance in planning for end-of-life care.  Until this form was adopted, health care providers relied on the DNR/DNI form which asked black and white questions about cardiopulmonary resuscitation (CPR) and intubation (breathing tube, ventilator) for life-threatening emergencies.  However, as we all know, decisions related to health care involve many areas of gray, and the MOLST form recognizes some of these nuances. 

While the MOLST form does include questions regarding CPR and intubation, it also addresses other less invasive forms of medical care.  These questions include whether an individual wishes to receive intravenous fluids, artificial nutrition (feeding tube), non-invasive ventilation (bi-PAP or C-PAP), or dialysis.  There are queries regarding duration of treatment and whether a person wishes to be transferred to a hospital for medical care. 

The MOLST form should be completed in consultation with your physician.  For more information, please see the following link:      


Healthy Care Proxy

When healthy, we are able to make informed decisions about our own medical care.  What happens to an individual who becomes cognitively impaired and is no longer able to make such decisions? A health care proxy is someone who is given the legal authority to make medical decisions on behalf of another person.  The health care proxy is not “activated” until an individual is deemed incapable of giving informed consent to medical treatment.  When selecting a health care proxy, it is important to make sure the proxy understands a person’s wishes and goals of care should a serious illness develop. 

The Commonwealth of Masssachusetts offers an easy-to-complete form by which a person may appoint two health care proxies (a primary health care proxy and a back-up).  This form may be found here:


Living Will

After completing the MOLST form and selecting health care proxies, some individuals choose to create a living will.  A living will is a written narrative by which a person describes their goals of care should they develop a serious illness.  It serves as a guide for the health care proxy and medical providers when an individual is no longer able to express their wishes or make informed decisions regarding their own care.


Who Should Keep These Documents?

After creating these documents, it is important that these papers be made accessible to all parties who may be involved in that person’s medical care.  This includes:

  • Health care proxies (both the primary health care proxy and the back-up)
  • Medical team (physicians, hospitals, home care providers)
  • Immediate family members or close friends
  • Estate attorney


Where Do I Get More Information?

Primary care physicians are available to guide patients with their decision-making process.  Attorneys who specialize in estate planning may also provide counseling.   The following websites offer helpful information:


National Institute on Aging Information Center  

Centers for Disease Control and Prevention (CDC)


Wishing you good health,

Brad Weiner, MD


DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

Travel Health

Dr. Brad Weiner | March 10, 2016

You’ve purchased your airline tickets, reserved a hotel, and planned the itinerary for your trip.   Whether traveling for business or pleasure, you prepare in advance for your journey.   What clothes do I need to bring?  Should I stop delivery of the mail and newspaper?  Do I need my passport?  Have I packed my cables, chargers, and batteries?  Do I have all my toiletries?  Who will water my plants and feed the fish?  

Here’s another important question to consider:  do I need any vaccines or medications before my journey?

Nowadays, travel to destinations both near and far is commonplace.  As your physician, I want to make sure you are well prepared for a fun, safe, and healthy trip.   


What vaccines or medications do I need?

Luckily for you (and for me), the Centers for Disease Control (CDC) and its team of infectious disease specialists, epidemiologists, and public health experts monitor disease trends around the world.  The CDC’s Travelers’ Health page ( provides excellent, up to date information on the vaccinations and medications you may need to protect yourself.  

Here’s a brief run-down of the vaccinations you should receive regardless of travel plans, assuming your childhood immunizations were up to date.

  • Tdap (tetanus, diphtheria, pertussis) or Td (tetanus, diphtheria) booster: one dose of Tdap is recommended for all adults, followed by a Td booster every ten years.
  • Influenza (flu shot) vaccine: one dose every year.
  • Zoster (shingles) vaccine: one dose for all adults who are 60 years of age or older.  This is a live vaccine and therefore should be avoided in those who are immunocompromised or pregnant.
  • Pneumococcal 13 and Pneumococcal 23 vaccines: one dose of each vaccine, given at least 12 months apart, is recommended for all adults aged 65 years or older. Both vaccines are also advised for those who are 19 to 64 years old with an underlying medical condition that may increase one’s susceptibility to pneumonia.
  • Human papilloma virus (HPV) vaccine: recommendedfor all women and men through 26 years of age.
  • Meningococcal vaccine: advised for those at increased risk for exposure to meningitis.  This includes college students living in dormitories, military recruits, and those with functional or anatomic asplenia (without a spleen). 

Now, let’s take a closer look at some of the vaccines and prophylactic medications often recommended for travelers.  Depending upon your specific destination, your physician may recommend one or several of the following:

  • Hepatitis A vaccine: consists of two shots given six months apart. Recommended for those visiting parts of Africa, Asia, Central and South America, and Eastern Europe.  Hepatitis A is present in the United States and Western Europe, but is less common. 
  • Hepatitis B vaccine: administered as three injections over six months. The hepatitis B vaccine has been included as part of routine childhood immunizations since the early 1990’s, but is also advised for travelers who have not been previously vaccinated. 
  • Typhoid vaccine: available either as a single injection or four pills that are taken over eight days. This vaccine provides protection for up to five years. 
  • Malaria prophylaxis: antimalarial medication is indicated for travelers visiting an area that is endemic for malaria. Several antimalarial medications are available;  medication choice depends upon local susceptibility and resistance patterns.
  • Yellow fever vaccine:  delivered via injection, this vaccine is advised for those visiting a country where yellow fever is endemic (parts of Africa, Central America, and South America).  Only specially authorized providers may administer this vaccine.  Those who receive the vaccine are provided with an International Certificate of Vaccination or Prophylaxis (ICVP).  Be sure to bring this with you as some countries require this for proof of vaccination.  
  • Japanese encephalitis vaccine: transmitted via an infected mosquito, Japanese encephalitis is mostly found in rural agricultural areas in Asia.  This vaccine is recommended for those who plan to spend extensive time (multiple weeks) outdoors in an endemic, rural or agricultural community during Japanese encephalitis virus transmission season.  


How soon before my trip should I meet with my doctor?

It is always wise to plan ahead.  I recommend that you start preparing at least four weeks before your trip, but even earlier would be preferable.  Antimalarial pills are started two days to two weeks before travel, depending upon the specific medication chosen. The oral typhoid vaccine should be completed at least one week before travel, while the injectable typhoid vaccine should be administered at least two weeks before potential exposure.  Similarly, the yellow fever vaccine must be given at least ten days before your trip.  The hepatitis A and B vaccine series are administered over six months.   If you’re reading this and suddenly realize that your trip is two weeks away, don’t fret.   I recommend that you start the hepatitis vaccines as the initial doses may provide some protection;  you may then schedule the remaining doses following your return home. 


Where may I find more information?

I recommend the following resources:


Wishing you safe travels,

Brad Weiner, MD

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

Understanding Obstructive Sleep Apnea

Dr. Brad Weiner | January 04, 2016

Mr. R is a 64 year old executive who is experiencing fatigue.  He maintains a busy schedule both at work and home, but makes sure that he gets eight hours of sleep each night.  Despite setting aside this time to sleep, Mr. R does not feel well rested when he awakens each morning.  He becomes tired by the early afternoon and often naps in his office.  Mr. R's wife has observed her husband snoring at night, but has also seen him choke and gasp in his sleep.  Mr. R meets with his physician who recommends a sleep study to evaluate for the possibility of obstructive sleep apnea.

What is obstructive sleep apnea?

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder.   Under normal conditions, the muscles of the throat maintain airway patency.   For people with OSA, the muscles promoting this patency are overcome by forces that lead to transient collapse or blockage of one’s airway. 

Estimates suggest that up to 15 percent of males and 5 percent of females in North America meet criteria for OSA.  Risk factors include advancing age, obesity, male gender, and upper airway abnormalities.  Smoking, alcohol consumption, and use of sedating medications are other potential contributors.

What are the symptoms of obstructive sleep apnea?

Snoring is one of the most common presenting symptoms of OSA.  Restless sleep, frequent awakenings, choking, and gasping are often reported.  Those with OSA sometimes feel fatigued upon awakening in the morning and may note excessive daytime sleepiness. 

How is obstructive sleep apnea diagnosed?

When OSA is suspected, a physician may order a polysomnogram (sleep study).  During this study, the number of disordered breathing events per hour of sleep is measured and is called the apnea-hypopnea index (AHI).  

Apnea is characterized by the complete cessation of airflow that is brief and resolves on its own.  Hypopnea is distinguished by a reduction in airflow without total stoppage of breathing. 

Why should I treat my obstructive sleep apnea?

Untreated moderate to severe OSA is associated with increased risk for developing hypertension, heart failure, coronary artery disease (CAD), and stroke.  A higher incidence of diabetes has been reported.  Untreated OSA may also contribute to difficulties with concentration, impaired cognition, and may escalate one’s risk for a motor vehicle accident.  

How do I treat obstructive sleep apnea?

There are several strategies available to treat OSA.  The goal of therapy is to open one’s airway and, thus, restore normal airflow during sleep.   When developing a treatment plan, many factors are considered including the severity of the diagnosis (as measured by the sleep study), potentially reversible causes, and an individual's medical history. 

Mild obstructive sleep apnea: 

For those with mild OSA, lifestyle changes may be all that is necessary.  Some of these interventions include:

  • Weight loss. Overweight individuals may benefit from weight loss.  Extra weight applies increased pressure to one’s airways, making it more difficult for air to pass through. 
  • Side vs. back sleeping. Sleeping on one’s side may promote airway patency. Use pillows and other devices to help maintain a side position.
  • Exercise regularly. Exercise may help one lose weight and improve lung function.
  • Avoid alcohol and sedating (sleep) medications which may relax the airway muscles and thus contribute to sleep apnea.
  • Treat nasal congestion. Those with allergies and a stuffy nose may benefit from a spray or allergy medication to unblock their nasal passages.

Moderate to severe sleep apnea:  

CPAP (continuous positive airway pressure) is the gold standard for those with moderate to severe OSA.  The CPAP device blows constant and continuous air through one’s nose and/or mouth.  This positive air pressure prevents airway collapse while sleeping.   For those who struggle to find a comfortable fit with their CPAP device, a mask fitting at a local sleep clinic may be beneficial. 

Are there other treatment options?

Some individuals with mild sleep apnea may benefit from using an oral appliance made by a dentist.  These dental appliances help keep one’s airway open by advancing the mandible and preventing blockage by the tongue.  Oral appliances are not as effective as CPAP for treating OSA, but are an option for those who have difficulty tolerating CPAP.   

Lastly, surgery is available for those with moderate or severe sleep apnea whose symptoms do not respond to the lifestyle changes and measures described above. 


We encourage you to speak with your physician if you feel you are experiencing symptoms of sleep apnea.


Wishing you a happy and restful New Year.

Brad Weiner, MD

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

The Flu Vaccine Has Arrived at PersonalMDs

Dr. Brad Weiner | September 29, 2015

Our New England weather has turned cooler over the past few days, reminding us that summer is coming to a close and winter is only a few months away. Soon the leaves will change into brilliant hues of yellow, orange, and red, followed by our first frost, our first snowfall, and then the start of influenza (flu) season.

Flu season usually reaches peak activity during January, February and March, but sometimes arrives as early as December. PersonalMDs has received its first shipment of flu vaccine and we would like you to come in for your flu shot.

Some important reminders about influenza:

What is the flu?

Influenza, or the flu, is a contagious viral infection. Typical symptoms of the flu include a fever (100-103F) for three to five days, shaking chills, diffuse muscle aches, and fatigue. A sore throat, cough, and runny nose may develop. Nausea, vomiting, and diarrhea may also sometimes occur.

How long does the flu last?

Typically, symptoms last for one to two weeks, but recovery may be slow. It is not uncommon to feel unwell for up to three to four weeks.

Why all the fuss over the flu?

While most people have a self-resolving illness, potential complications include pneumonia, dehydration, or an exacerbation of an underlying medical condition such as asthma, diabetes, congestive heart failure, or kidney disease, and in rare instances, death.

Who should get the flu shot?

Everyone older than 6 months. Young children, pregnant women, the elderly, and those with chronic illness are most vulnerable. Please check with your physician first if you have a fever or a severe egg allergy.

Why should I get a flu shot?

When you receive the flu vaccine, you are not only protecting yourself, but you are also protecting your family members, friends, colleagues, and other members of your community.

Does the flu shot work?

The quadrivalent flu vaccine offers protection against two strains of influenza A and two strains of influenza B. When the vaccine’s strains match those circulating in the community, the vaccine provides protection. Last year’s flu shot did not match all of the circulating strains, so people were still susceptible to the flu. Despite the lack of a perfect match, the flu shot still offered some protection and is therefore worthwhile.

Will the flu shot give me the flu?

No. You cannot get the flu from the flu shot. This type of vaccine contains an inactivated virus which is dead and cannot cause the flu. Frequently, the “flu” that people develop after receiving the vaccine is another viral upper respiratory infection, but it is not influenza. Remember, the flu shot is administered during the fall and winter months. This coincides with the peak season of the common cold. For those of you who develop an actual case of influenza shortly after the flu shot, you were going to get the flu anyways. The flu vaccine takes approximately 10 to 14 days to “kick in” before it starts to provide you with protection.

How do I get the vaccine?

We welcome you to stop by our office anytime from Monday to Friday, between 8:30am and 4:30pm. No appointment is necessary. You may also request the vaccine during a routine office visit with your physician.

Wishing you a happy, healthy, and flu-free winter!

Brad Weiner, MD

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.

Summer Tick Safety

Dr. Brad Weiner | August 08, 2015

Summertime is one of my favorite seasons. Warm weather, endless outdoor activities, and extra hours of daylight bring the color back to our cheeks after a long winter.

Last weekend, I attended a barbeque in one of Boston’s picturesque suburbs. Guests mingled on a patio adjacent to a well manicured backyard. Deep blue skies, great company, and lemonade combined to make this a perfect summer day, until one guest spotted a tick crawling along her arm. Not long afterwards, another guest discovered a tick traipsing across his neck. These little critters quickly reminded us that the arrival of summer also heralds the arrival of peak tick activity in New England.

Starting in the spring and continuing throughout the fall, PersonalMDs fields phone calls from patients reporting of tick bites. Many express concern about their risk for developing Lyme disea se.

Lyme disease is the most common tick-borne illness in the United States, and is caused by the bacterium Borrelia burgdorferi. In the northeastern United States, Borrelia burgdorferi is transmitted to humans by the deer tick, Ixodes scapularis.

Deer ticks often reside on tall grasses and shrubbery. They may attach to any part of the human body, but are commonly found in difficult-to-see areas such as the scalp, behind the ears, underneath the armpits, inside the bellybutton, around the waistline, between the legs, and behind the knees.

Image courtesy of CDC

Measures to prevent tick bites include:

  • Avoid walking in tall grasses, brush, or other areas where ticks are abundant.
  • Wear protective clothing including long pants and long sleeves when entering wooded areas.
  • Apply a repellant containing DEET to skin and clothing.
  • Perform routine, full-body tick checks with a mirror after outdoor activities.
  • Bathe or shower within 2 hours following exposure to tick environments.

Generally speaking, a tick must be attached for 48 hours or longer to transmit Lyme disease. If you find a tick attached to your skin, do not panic. You have time to ensure proper removal.

We recommend the following steps for removal:

  • Locate a pair of fine-tipped tweezers or small forceps.
  • Grasp the tick as close to the skin as possible.
  • Pull straight upwards with firm but steady pressure.
  • Do not twist or jerk sideways. This may cause part of the tick to break off and remain in the skin. If this happens, do not worry. Leave it alone and your body will eventually expel the remaining tick part.
  • Cleanse the area afterwards with soap and water.

Please call your physician if you discover a tick that may have been attached for 48 hours or longer. We may then prescribe a prophylactic dose of antibiotics to reduce your chance of developing Lyme disease.

Note that it is common for some people to develop a small, raised, red rash at the location of the tick bite that is about the size of a penny. This is not Lyme disease, and usually resolves on its own within a few days.

After removing the tick, we recommend observation for the following symptoms and signs:

  • Erythema migrans (EM) is an enlarging red rash at the site of the tick bite. An EM rash may become quite large and may develop central clearing, creating a bullseye appearance.
  • Fever, chills, fatigue, muscle aches and pains, headache, or enlarged lymph nodes.
  • EM rashes located elsewhere on the body, joint swelling (such as the knee), Bell's palsy, or palpitations.

Image courtesy of CDC

We would like you to call us if any of these symptoms develop.

Wishing you a happy and healthy summer!

Brad Weiner, MD

DISCLAIMER: This blog is for informational purposes only. It does not replace medical care from a licensed physician. Please contact your doctor if you have any questions or concerns.