• June 21, 2016 /  Basics, Difficult Conversations

    sensitive subjectsThis is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005. Reprinted April 2010.)

    For many, it’s hard to discuss topics like depression, grief, family issues, incontinence, and alcohol use with their doctor. It may feel awkward to bring up such personal matters. The fact is, though, that doctors are used to talking about these things with their patients. After all, the very nature of the doctor-patient relationship is personal. Let’s take a look at some of the subjects you may hesitate to bring up.

    Depression and Grief

    One of the most difficult aspects of growing older is facing the loss of your spouse, friends, and other important people in your life. This would be tough at any age, but can be even more significant at an older age when the losses are compounded.

    Mourning is normal, but clinical depression is not. Take note when feelings of sadness are constant, last more than a few weeks, are accompanied by poor or increased appetite, and lack of energy. If this applies to you, it’s time to talk to your doctor. As the booklet says, “A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.”

    Problems with Family

    Another issue that can cause emotional distress is difficulty with your family. Age and illness can bring severe stress to any family, even those who are normally very loving. You may feel that family issues should be kept private. Remember, though, that your doctor is trained to offer you valuable assistance in these areas. If you feel you’re being abused emotionally, physically, verbally, or even financially – speak up!

    Falling, Incontinence, and Memory Problems

    Since falling can be very serious for an older person, many develop a real fear of it. It could prevent them from doing the things they usually enjoy, or from trying new activities. However, you can become weaker and frailer through this, hence increasing your chances of actually falling! Gentle and specific exercises can help, and your doctor can advise you about these.

    Incontinence is an embarrassing subject for many. You may be surprised to learn that there are many useful exercises and medications to assist you in controlling your bladder. Don’t hesitate to ask your doctor for help because of fear of embarrassment. It’s worth it to improve your quality of life!

    It’s not uncommon to experience some issues with memory as you age. That doesn’t make it any less distressing, however. The booklet assures you, “For most older adults, thinking and memory remain relatively intact in later years.” If you or your family members do notice a change in function, be specific when talking to you doctor about it. Tell them which parts of your life it’s affecting. There’s no reason you should suffer in silence.

    Alcohol and Sexuality

    These two matters are especially sensitive for many. Alcohol moderation is important, though, because the effects on a person may change or increase in later years. Depression and loss, discussed earlier, can even contribute to one misusing alcohol as a coping mechanism. One way to bring this up, the booklet suggests, is by saying something like, “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?”

    Some assume that aging means sexuality will decrease or worsen. This doesn’t need to be the case! Many have a healthy sex life long into their later years. Most doctors recognize this. If you aren’t satisfied with your sex life, it could be because of a medication or disability. Don’t be shy bringing this up. Let them know you have a personal question to lead into the topic. Be assured they’ll be very understanding.

    It’s important to have a doctor you can discuss these sensitive topics with. What if you’re uncomfortable with yours? Try being direct with them. Tell them your issue and how it makes you feel. Misunderstandings happen, and communication fosters trust. If you truly don’t feel satisfied, though, it may be time to look for a new one. Your comfort matters, and you need support while coping with these changes.

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  • September 14, 2015 /  Basics

    This is from the Home Care Assistance website: http://homecareassistance.com/expert-advice-on-how-to-reduce-fall-riskFalling

    Q: What are some of the recognizable signs that an individual is at-risk for a fall?

    A: The common fall risk assessments are a good place to start. Following the completion of these assessments, I would look at the below list of questions to assess why the person was at risk, how at risk was he or she, and offer some suggestions about how to change the situation.

    • How many times can a person stand up and sit down well?  (This shows his/her balance and strength)
    • How far can a person reach without moving his or her feet?  (This shows balance and accommodation to loss of balance)
    • How well does a person stand – how does he or she get started and how steady is he or she once up? (This demonstrates his/her ability to plan movements and accommodation to change)
    • Can the person get up off the floor well?  (This single exercise might make the most difference in confidence, strength, endurance and balance as well as confidence for the client, caregiver or family)
    • Can the person roll and change positons on the bed well? (These moves help people remember how to move well, maintaining motor cognitive skills and motor memory)
    • How clear is the floor where he or she walks and what is the quality of the things the person hangs on to walking around?
    • How well can he or she see changes in walkways such as steps or bumps?  How is his or her vision and the person’s ability to use their vision (e.g. looking around a room)?
    • How variable is his or her skill level when it comes to walking based on fatigue, blood pressure, hunger, medication, pain, etc.?

    Q: Any other thoughts?

    A: It is important to understand that strength is not enough to maintain balance. Engaging in meaningful, active tasks is one way an occupational therapist can help people maintain balance. Routine exercises tend to lack interest and effectiveness. However, exercises are a good start and more effective if the person keeps them up. Another way to start working on balance is to “just stand up” because once the person is able to stand more easily, the more likely he or she is to be active, which is the best exercise of all.

    Julie Groves, Occupational Therapist (OTR/L), graduated with a degree in Occupational Therapy from the University of Puget Sound in Tacoma, Washington and has over 30 years of professional experience in occupational therapy. Groves currently serves on the Board of Coda Alliance, Silicon Valley Community Coalition for End-of-Life Care and is a regular speaker at the San Jose State Occupational Therapy Department. Her awards include the Occupational therapy Association of California President Award (1991) and Special Contribution Award for the Santa Clara Chapter OT Association (1993), and she is a Bay Area leader in the field of occupational therapy.  She was just nominated for the Occupational Therapy Association of California’s Entrepreneur of the Year Award.

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  • July 27, 2015 /  Basics, Dementia, Resources


    www.Caregiverstress.com Sponsored by Home Instead Senior Care Services

    Senior sexuality represents possibly the last remaining taboo. No one wants to talk about it. In a 2013 survey conducted by Home Instead, Inc., fewer than one-third of adult children said they were even the slightest bit comfortable talking to their parents about senior sex.

    And that’s a problem, because certain medical conditions—like dementia and Alzheimer’s disease—can cause seniors to engage in inappropriate sexual behavior. This development can be disturbing for adult children and caregivers alike, and it can be difficult to manage. As a senior care professional, you can help your clients address these behaviors by sharing some tips and resources.

    Defining Inappropriate Sexual Behavior

    Let’s be clear about one thing: not all sexual behavior by seniors is “inappropriate.” Many seniors enjoy healthy sex lives well into older age. A study by the New England Journal of Medicine found 25 percent of seniors over age 75 are having sex, and about 50 percent of those between ages 65 and 75 are also sexually active.

    No matter the age of the adult participants, consensual sexual behaviors can be considered normal and healthy—as long as the participants retain the cognitive ability to consent.

    When Sexual Behavior Becomes Inappropriate

    Unfortunately, cognitive decline can cause seniors to engage in inappropriate sexual behaviors outside of a loving relationship or in unsuitable environments. These behaviors can cause distress for family members and caregivers who may feel ill-equipped to deal with them.

    Let’s look at three common situations and how to cope with them.

    1. Masturbating in public

    “My father had vascular dementia. He started masturbating in public. Of course, I was appalled when I was told this and then I witnessed it. (I guess a part of me was hoping that I was being told incorrect info.)”

    If a family caregiver asks you for guidance regarding a senior loved one who is fondling himself in public, you might advise them to start with a medical examination. In seniors who can’t communicate well, public masturbation may signal a medical issue, such as pain or a urinary tract infection. These medical causes may be ruled out (or treated) with a physical exam conducted by a skilled geriatric practitioner.

    In our anonymous family caregiver’s case, a trip to the doctor did the trick. She said, “I involved his MD, who examined him, and then gave him a low dose of an anti-depressant medicine. The behavior stopped.”

    1. Inappropriate or unwelcome touching of others

    “My mom seems to have a problem sometimes. My hubby will give her a hug as he always has. But occasionally she puts her hands where they shouldn’t be. So hubby tries to avoid her… which confuses her when she wants that hug.”

    Sexual inappropriateness with dementia certainly is not limited to men. As this comment illustrates, women can develop wandering hands, too.

    One way to cope with wandering hands during embraces is to develop a new way to hug. Follow these steps:

    • As you approach the senior, stop a short distance away and raise both hands in front of you in a “stop”-like gesture. Smile and make eye contact.
    • Verbally encourage the senior to raise her hands in the same position.
    • Move forward and place your palms against hers. Quickly interlace your fingers to hold onto her hands.
    • Now that the senior’s hands are secured, you can guide their hands toward your shoulders as you lean in for a ‘hug,’ to touch cheeks or to give your loved one a kiss.
    • When the embrace is finished, back away and release the senior’s hands.

    This method allows seniors to enjoy the physical touch of family members while ensuring hands don’t inadvertently wander where they shouldn’t go.

    1. Stripping in public

    Because Alzheimer’s disease and related dementias reduce a person’s inhibitions, seniors with these conditions may not realize it’s inappropriate to take their clothes off in public. If a family member seeks your guidance on this issue, it’s important to point out this behavior may not be sexual in nature at all.

    Seniors with dementia may disrobe in public for a variety of reasons, from feeling too warm to experiencing an urgent need to urinate. If family members can figure out what triggers the behavior, they may be able to resolve the underlying issue.

    In the meantime, family members can manage the activity as it occurs. Advise them to always take a shawl or throw with them to cover their family member as the clothes come off. Help your clients find resources for clothing that is difficult to remove, such as items with fasteners in the back. Encourage family members to stay calm and not to shame their loved one. Be sure family members know their loved one cannot necessarily control this behavior.

    Keep the Conversation Going

    As a senior care professional, you have the opportunity to bring senior sexuality out into the open. While adult children report reluctance to talk about this subject, they seem to feel relieved when someone broaches the topic to them. As another member of the Alzheimer’s Reflections community put it:

    “I have been a caregiver for the past 18 years. In all that time I have never had that issue come up. It actually had never even occurred to me! How awesome that you have brought this subject to the forefront for discussion if the need arises!”

    This is the link for the article:


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  • July 14, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    Planning for care in the event of a serious illness is much like planning for your death, the only difference is that instead of planning for the care of your estate you are planning for the care of…you!

    Think for a moment: What happens to you if you get sick? You can probably handle that. Now what happens if you get really sick, like a flu or diarrhea that leads to dehydration? That’s a little more difficult. Now what happens if you fall and break your arm, leg or hip? Or maybe you get some serious pneumonia or, heaven forbid, cancer (I mean the life threatening kind)? Now the worst: what happens if your mind is not working and you can’t make decisions? Do you have a plan in place?

    Who cares for you in these situations?

    Along with a will or a trust a person should have an Advanced Health Care Directive (AHCD). Advance directives are written instructions letting others know the type of care you want if you are seriously ill or dying. These can be in the form of a health care proxy or a living will.

    A living will records your end of life wishes for medical treatment in case you are no longer to speak for yourself. I have seen these inserted into an estate plan in the section generally titled: Advanced Health Care Directive. I have also seen additional directives outside the estate plan: a Do Not Resuscitate (DNR) form or a Physicians Order for Life Sustaining Treatment (P.O.L.S.T.). The DNR is just signed by you but the P.O.L.S.T. is signed by you and your doctor (hence the phrase, “Physician’s Order”. The P.O.L.S.T. for is a little more comprehensive and is printed on bright pink paper so that emergency personnel are more likely to see it among the sea of white papers in a binder or on a refrigerator (think EMT). You may want to visit http://capolst.org/ for more information.

    Health care proxies, or agent/attorney in fact/surrogate, should a be a person you choose to advocate on your behalf to ask questions and find resources when you can’t or carry out your instructions listed in your P.O.L.S.T. or other directives.

    While AHCD’s are legally valid everywhere in the United States, each state has its own laws regarding format and wording. You will need to check with your attorney regarding the laws in your state. For example, the P.O.L.S.T. is accepted in California but not in Oklahoma. According to the According to the National POLST organization (http://www.polst.org/ ) many states are now going through the process of accepting this form but you will still need to discuss this with your attorney.

    Paying for medications

    This is a direct quote from the pamphlet:

    “Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. If the doctor does not know the cost, ask the pharmacist before filling the prescription. Then call your doctor and ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?

    Your doctor may also be able to refer you to a medical assistance program that can help with drug costs.”

    In case you weren’t aware, Medicare prescription drug coverage is available to people with Medicare. For information call 1-800-MEDICARE (1-800-633-4227) or visit the Medicare website atwww.medicare.gov

    Independence issues

    What about driving?

    In my post on December 10, 2013 I discuss the difficult conversation your loved one might have with you regarding driving. If you find that it is becoming more difficult to drive, it’s harder to see the road, you are bumping into things, and drivers are getting worse when they drive around you then it may be time to hang up the keys. Your doctor may have access to resources or organizations to help you plan for these events. It would make it easier on your family and the people around you if you do the research first on public/private transportation availability and recognize that if they approach you that they really are concerned.

    Assisted living

    I very rarely have clients that want to move into assisted living from their homes but if it becomes difficult for a home helper or caregiver to assist you and you find that you are not getting out to socialize then it may be time to move into an assisted living community. I will dedicate a whole post regarding this issue because there are still a lot of ways to stay at home that you may want to investigate before you make this decision.

    Woman reading

    Next: Discussing Sensitive Subjects

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  • July 7, 2014 /  Basics

    Talking with your Doctor – If you are hospitalized

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    The pamphlet does not mention this but I believe one of the more important things you will need to do is notify the person who is your agent on your medical power of attorney, commonly known as an Advanced Health Care Directive (AHCD) or the person who is going to act as your advocate. It does not matter whether or not your visit to the hospital is a routine surgery, you need to make sure your agent knows the details. The will need to know the questions to ask in the event that you are not able to ask. They will need to know the name of your primary physician (PrP) and you need to let your PrP know your advocate may be contacting him/her in the case of emergency. While your PrP may not have any authority at the hospital he/she may have vital information that will help the hospital doctor in assessing and prescribing treatment for you.

    The pamphlet suggests that hospitals have routines and you may be able to make requests of service within those routines. For non-emergency visits there is generally a preparation period. During that time you can ask some of your questions. If you ask for the normal times your doctor is likely to visit you can prepare to have some of the more difficult questions ready when he/she visits. During emergency visits your advocate will need to ask the questions for you if you are not alert. At a minimum  and if possible, they should at least be present when the doctor explains what they are going to do and the reasons for their procedures.

    Questions for non-emergency visits

    • How long can I expect to be in the hospital?
    • When will I see my doctor?
    • What doctors and health professionals will I see?
    • What is the daily routine in this part of the hospital?

    Questions for emergency visits

    • Will you talk to my primary doctor about my care?
    • Do I need to arrange any further care? (it has been my experience that the discharge nurse or social worker will let you know)
    • May I get instructions for further care in writing? (I have found that the hospitals I have worked with all provide written instructions when they discharge you. The issues I have seen is that the patient is not usually alert enough or too distracted to ask questions at this time. This is the time for your advocate to ask. If they were not present when the doctor or staff came through then have them call the discharge nurse or social worker to ask the questions)
    • Is there someone here who speaks my language and can explain the instructions? (I am assuming here that the person reading this is advocating on behalf of a patient who doe not understand English. Hospitals are required to provide a translator or at least have the instructions written in the language of the patient. This is another good reason to have an advocate)

    Second Opinions

    This is directly from the pamphlet:

    When surgery is recommended, patients often seek a second opinion. Hearing the views of two different doctors can help you decide what’s best for you. In fact, your insurance plan may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case.

    Always remember to check with your insurance provider in advance to find out whether a second opinion is covered under your policy, if there are restrictions to which doctors you can see, and if you need a referral form from your primary doctor.”

    doctor consults with patient

    Next time: Practical Things

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  • June 30, 2014 /  Basics

    Did you know?

    • Physicians, on average, interrupt patients within the first 23 seconds of their opening comments.[i]

    Interruption is a pervasive communication style with doctors.  In a well-known study by Beckman and Frankel patients were allowed to complete their opening statement expressing their agenda in its entirety in only 23% of physician interviews.  The average time to interruption was 18 seconds.  This study’s findings have been replicated by several others.  In a more recent study of primary care residents, patients were allowed to speak for only 12 seconds on average before they were interrupted.  Female patients experience interruption more frequently than males. In contrast, studies have suggested higher rates of patient satisfaction with physician visits during which patients and doctors interrupt at similar frequency and also with visits in which there is more “reflective” silent time during the conversation.  Perhaps the tendency to interrupt extends to all physician derived professional communications, as in my case with the neurosurgeon on the phone.

    Why do physicians interrupt?  In practical terms, throughout the course of a given day a physician may be tasked with listening to twenty to thirty patient derived histories and with solving difficult problems for each of these patients in a matter of ten to fifteen minutes. This is a tough, if not impossible job.  Consequently, once a physician believes that the meat of the story is out there, he or she may respond and interrupt before hearing details that the patient (or colleague) feels are important.  In more abstract terms interruption is a communication strategy that reinforces physician dominance in the hierarchy of the patient-physician relationship.


    It is interesting to note that there are a plethora of sites dedicated to how do doctors talk to patients. The following link is to the final session of a seminar given at the Mayo clinic. This is a woman talking to doctors about how to talk to patients. I thought you would like to know that if communication in marriage is hard, it is equally as hard in the medical field.


    • Physicians do not ask patients if they have any questions in more than 50 percent of outpatient visits.[ii]
    • Physicians typically spend less than one minute of a typical visit discussing new prescriptions.[iii]
    • Patients are afraid to ask their doctor questions for fear of appearing to challenge them.[iv]

    Next time: If you are hospitalized

    conversation with doctor

    [i] Marvel MK, Epstein RM, Flowers K, Beckman HB. (1999 Jan 20). “Soliciting the patient’s agenda: have we improved?” JAMA, 81(3): 283-7.

    [ii] Naik AD, Kallen MA, Walder A, Street RL Jr. (2008 March 18). “Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.” Circulation, 117(11): 1361-8.

    [iii] Tarn DM, Paterniti DA, Kravitz RL, Heritage J, Liu H, Kim S, Wenger NS. (August 2008). “How Much Time Does It Take to Prescribe a New Medication? Patient Education Counseling. 72(2): 311-319.

    [iv] Frosch DL, June SG, Rendle KA, Tietbohl C, Elwyn G. (June 2012). “Authoritarian Physicians and Patients Fear of Being Labeled “Difficult” Among Key Obstacles to Shared Decision making.” Health Affairs, 31(5): 1030-38.

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  • June 23, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    There may come a time when your needs take you beyond your doctor’s abilities and he or she refers you to a specialist. According to the booklet, you may even request one yourself but you will need to check with your insurance plan for any requirements regarding referrals from your primary doctor. When you finally visit the specialist you should prepare to ask questions in the same way you would with your doctor.

    The specialist should have already seen your medical records or test reports. While the booklet doesn’t say this I think a good specialist will ask questions first before discussing the diagnosis. I say this because there may be things the generalist misses or you may not have thought to disclose. I find it is also a safety feature so that they are diagnosing the patient they think they are meeting. Have you noticed that even in a regular appointment that each new nurse will ask the same questions that last one did and then the doctor usually asks them again? At least it seems to work that way in the big organizations. The small offices may not operate that way but when going to the specialist, one whom you have not visited before, they should be asking questions of you before any discussion of diagnosis.

    When they start describing their diagnosis they will probably use terms that you are unfamiliar with. Ask them about the terms. Don’t be hesitant to say, “I don’t know much about that. What does that mean?” If you are still wondering, ask for materials or referrals to other sources for research. The booklet recommends that you have the specialist send material to your doctor. That allows him/her to be part of the discussion and keep track of your medical care.
    Here are some questions you might ask your specialist:

    • What is your diagnosis?
    • What treatment do you recommend? How soon do I need to begin the new treatment?
    • Will you discuss my care with my primary doctor?


    Next: Things You May Experience When Talking with Your Doctor

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  • June 16, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    Do you search for information on the internet? It is a great resource but here are some questions to ask because not all information is reliable. The following questions may be useful to consider when you look at a health-related website.

    • Who is responsible for the content? Is it a government agency, national nonprofit organization, or professional association? An individual? A commercial organization?
    • If you are reading a particular article, what are the author’s credentials? Is the author affiliated with any major medical institutions?
    • Who reviews the material? Is there a medical advisory board that reads the medical content before it is made available to the public?
    • Are sources cited for the statistical information? For example, it’s easy enough to say “4 out of 5 doctors agree…” but where did that statistic come from?
    • Is the purpose and goal of the sponsoring organization clearly stated?
    • Is there a way to contact the sponsor for more information or to verify information presented?
    • Is the site supported by public funds or donations? If it includes advertisements, are they separate from content?
    • Because health information gets outdated so quickly, does the website post the source and date for the information?
    • If you have to register, is it clear how your personal information will be used? Does the site have a clear privacy policy?
    • Is the website trying to sell you something? Don’t forget to talk with your doctor about what you’ve learned online.

    That last suggestion is very important…don’t forget to talk with your doctor about what you have learned!

    evaluating health advice

    Next article: Talking to Your Doctor in Special Situations

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  • June 9, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    In a sidebar on page 20 is this encouragement:

    “Exercise is often “just what the doctor ordered!” Exercise can:

    • Help you have more energy to do the things you want to do.
    • Help maintain and improve your physical strength and fitness.
    • Help improve mood and relieve depression.
    • Help manage and prevent diseases like heart disease, diabetes, some types of cancer, osteoporosis, and disabilities as people grow older.
    • Help improve your balance.

    Many doctors now recommend that older people try to make physical activity a part of everyday life. When you are making your list of things to talk about with your doctor, Ask how exercise would benefit you, if there are any activities you should avoid, and whether your doctor can recommend any specific kinds of exercise.”

    According to the National Institute on Aging they list all the above items with the incentive that exercise also helps you remain independent or less dependent on others. They go into more detail such as:

    Four types of Activities – 1) those the build endurance, 2) build strength, 3) maintain balance and 4) maintain or build flexibility.

    You may want to visit their website: http://www.nia.nih.gov/health/publication/exercise-and-physical-activity

    speaking of exercise

    Next article: Evaluating Health Information on the Internet.

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  • June 2, 2014 /  Basics

    This is a continuing series using information from the booklet written by the National Institute on Aging working with the National Institutes of Health called: Talking with Your Doctor. (U.S. Department of Health and Human Services, NIH Publication No. 05-3452 August 2005 (Reprinted April 2010)

    Doctor advises patient

    Once you have established good communication, the kind that involves not only getting information but also giving it, you will need to work with your doctor on a plan of action.

    Keeping in mind the two way communication…

    Ask about different treatments.

    Whether it is medication or surgery you will need to ask questions. Let’s say that your doctor is prescribing medication for diabetes. Ask, “What are the pro and cons of the medication?” “Do I have any other choices besides this or any medication?” The same questions are good for the surgery. Most doctors will probably be discussing this with you anyway but in the event they don’t you need to ask. If you are uncomfortable with the treatment prescribed then practicing good communication, you need to let your doctor know that.

    Here is a summary of ideas to help with your discussion:

    Ask about different treatments:

    • Are there any risks associated with the treatment?
    • How soon should treatment start?
    • How long will it last?
    • Are there other treatments available?
    • How much will the treatment cost?
    • Will my insurance cover it?

    Ask about prevention:

    • Is there any way to prevent a condition that runs in my family—before it affects me?
    • Are there ways to keep my condition from getting worse?
    • How will making a change in my habits help me?
    • Are there any risks in making this change?
    • Are there support groups or community services that might help me?

    Next article: Speaking of Exercise

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