• May 5, 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)

    Asking Questions About Your Medications

    Doctors will usually prescribe medication for a symptom. This section will help guide you through some of the items you need to think and ask about. This section in the booklet does not discuss the world of alternative medicine and only hints of it a little later. The point though is that no matter where you go the person, whether a doctor or personal care manager, must know the information you have and you must ask them questions. Open and honest communication is a must. So…

    The first thing is to understand why the medication is being prescribed. The doctor usually will write down the name of the medication, instructions and anything of note that he/she thinks you need to know about the prescription. Here is a list of suggested questions:

    • What are the common side effects? Did you know that sometimes medications affect older people differently than younger people? If the medication doesn’t seem to be working tell your doctor but the booklet recommends that you ask your doctor first before you stop taking it.
    • What should I pay attention to?
    • When will the medicine begin to work?
    • What should I do if I miss a dose?
    • Should I take it at meals or between meals?
    • Do I need to drink a whole glass of water with it?
    • Are there foods, drugs, or activities I should avoid while taking this medicine?
    • Will I need a refill? How do I arrange that?

    I emphasize and so does the booklet on page 16 that it is important to include your pharmacist in the discussion. They are trained specifically in the art and science of medications. They generally have a greater understanding of the side effects and drug interactions and, if you use the same store each time you order, they have your records there and you can ask them for an interaction or side effect analysis each time a new prescription is issued. The booklet also emphasizes, as I did in the previous article, that if you use another doctor (such as a specialist) make sure that your doctor knows what they prescribed (and check in with your pharmacist as well).

    You should have a handy list of all your medications. The list should include:

    • The name of the drug
    • What it is for
    • Color/shape
    • Date started
    • Doctor prescribing it
    • Dosage
    • Instructions

    Here are some common abbreviations doctors use when prescribing medications (just for fun, I’ve included what I think are the Latin phrases associated with the translation):

    p.r.n. (Pro Re Nata) as needed

    a.c. (Ante Cibum) – before meals

    q.d. (Quaque Die) – every day

    p.c. (Post Cibum) – after meals

    b.i.d. (Bis in Die) twice a day

    h.s. (Hora Somni) – at bedtime

    t.i.d. (Ter in Die) – three times a day

    p.o. (Per Os) – by mouth

    q.i.d. (Quattuor in Die) – four times a day

    ea. Each

    The booklet includes a chart for keeping track of your medications. I know this is especially handy if you have several prescriptions.pills laid out

    Next: How Can I Be Involved: Making Decisions With Your Doctor

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  • April 28, 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)

    What Can I Ask? Getting Information

    A good detective asks questions. Most doctors don’t volunteer a lot of information. They may run a quick exam on you and then ask you to go have your blood drawn or they may want you to have an x-ray taken. It is not out of line to ask for the reason(s), what is his/her concerns. As you may already know, some of these tests are just part of the routine and really don’t raise a concern but if you brought a symptom to your doctor is it best to ask what he/she is looking for or hoping to uncover with the test. Here are some questions the booklet suggests asking:

    • Why is the test being done?
    • What steps does the test involve?
    • How should I get ready?
    • Are there any dangers or side effects?
    • How will I find out the results?
    • How long will it take to get the results?
    • What will we know after the test? 

    Of course, when the results are ready, make sure the doctor tells you what they are and explains what they mean. By the way, the booklet also recommends that you ask your doctor for the definitions of any terms that are unclear or unfamiliar to you like aneurysm, hypertension, infarct or for any directions that aren’t clear like taking medication with food; is that during or after a meal, or does that matter?

    If you are referred to a specialist it is easy to assume that they will send the results to your primary doctor but that is not always the case so ask that the result be sent.

    If the test(s) show results that are not favorable then discuss the diagnosis with your doctor. A diagnosis identifies your disease or physical problem. The booklet states that if you understand your medical condition, you can help make better decisions about treatment. If you know what to expect, it may be easier for you to deal with the condition. The following are some questions the booklet lists that you may want to ask:

    • Ask the doctor to tell you the name of the condition and why he or she thinks you have it.
    • What may have caused this condition?
    • Will it be permanent?
    • How is this condition treated or managed?
    • What will be the long-term effects on my life?
    • How can I learn more about my condition?

    Next: Asking Questions – Medicationschecklist items

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  • April 21, 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)

    What Can I Say – Giving Information

    This section gives ideas on what to talk about. I have found that few people are eager to share what is going on with their bodies for fear that something may be devastatingly wrong inside but many times early discovery of a disease will save the person or at least help prepare for the inevitable.

    It is important that you tell your doctor about your symptom(s). The booklet describes a symptom as “evidence of a disease or disorder in the body. Examples of symptoms include pain, fever, a lump or bump, unexplained weight loss or gain, or having a hard time sleeping.” While a doctor may perform exams and/or tests, it is your input that helps direct the doctor where to look.

    Before you start telling him/her your symptoms it is best to clarify what they are. The easy part is identifying them but when do that happen. Are they constant? If not, when do you experience them (frequency and duration)? When did they start? What are you doing or what have you done recently that may aggravate or ease the symptoms? Do they affect your daily activities? Which ones? How?

    The booklet makes the following recommendation:

    Take the time to make some notes about your symptoms before you call or visit the doctor. Worrying about your symptoms is not a sign of weakness. Being honest about what you are experiencing doesn’t mean that you are complaining. The doctor needs to know how you feel.

    It also states that it is very important to give information about your medications (especially if you are being seen by more than one doctor – example, did you go to the hospital recently and did that attending physician prescribe medication? If he/she did, your doctor would not know about it!) The booklet goes on to state:

    It is possible for medicines to interact causing unpleasant and sometimes dangerous side effects. Your doctor needs to know about ALL of the medicines you take, including over-the-counter (nonprescription) drugs and herbal remedies or supplements, so bring everything with you to your visit—don’t forget about eye drops, vitamins, and laxatives. Tell the doctor how often you take each. Describe any drug allergies or reactions you have had. Say which medications work best for you. Be sure your doctor has the phone number of the pharmacy you use.

    As you talk with your doctor you must be honest and let him/her determine what may or may not be important. Have your interests changed? For example, you used to be quite active but now you are tired all the time and so you no longer exercise. You may think that being tired is no big deal but your doctor can run a test that may determine if there is a chemical imbalance that is causing this. Did you know that changes like a loss of a loved one (including pets) is a big stress factor and it affects how you function? It has been shown that if there are several of these life changes in a short period of time that it can be debilitating. Your doctor should know things like if you have moved and why you moved. Did somebody move in with you or are you now living with somebody? Did you sell a home, have family move away (or nearby), drivers getting crazier and you are having more near misses?

    Look at this time with your doctor as being a detective partner. Instead of solving a crime you are solving the cause of your discomfort.talking with doctor on phone

    Next time: What Can I Ask?

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  • April 4, 2014 /  Basics

    In the following weeks I’ll be referring almost exclusively to a 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)

    Getting Ready for the Appointment

    The hope with this section is that the better prepared you are the better results you will get. A list is important as we tend to forget what it was that we wanted to discuss or compare or…well, you get the idea. Here are some examples the booklet suggests:

    [D]o you have a new symptom you want to ask the doctor about? Do you want to get a flu shot? Are you concerned about how a treatment is affecting your daily life?

    I thought about other items:

    Did you check for interactions between medications? How do I stop smoking? Lose weight? I’m having bladder issues, what do I do?

    Of course, you have to remember to bring the list with you! Oh, and take your glasses and hearing aid with you. This is NOT a time for vanity!

    The booklet continues:

    Consider bringing a family member or friend —

    Sometimes it is helpful to bring a family member or close friend with you. Let your family member or friend know in advance what you want from your visit. Your companion can remind you what you planned to discuss with the doctor if you forget, she or he can take notes for you, and can help you remember what the doctor said. If you need an interpreter you can and should bring one.

    Next week: What Can I Say – Giving Information

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  • March 24, 2014 /  Basics

    I’ll be referring almost exclusively to a free 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)

    http://www.nia.nih.gov/health/publication/talking-your-doctor-guide-older-people

    Consult reference sources

    “The Directory of Physicians in the United States and the Official American Board of Medical Specialties Directory of Board Certified Medical Specialists are available at many libraries. These books don’t recommend individual doctors but they do provide a list of doctors you may want to consider. MedlinePlus, a website from the National Library of Medicine, has a comprehensive list of directories (www.nlm.nih.gov/medlineplus/directories.html) which may also be helpful. There are plenty of other Internet resources too—for example, you can find doctors through the American Medical Association’s website at www.ama-assn.org (click on “Doctor Finder”). For a list of doctors who participate in Medicare, visit www.medicare.gov (click on “Search Tools” then “Find a Doctor”). WebMD also provides a list of doctors at www.webmd.com (click on “Doctors”). Don’t forget to call your local or State medical society to check if complaints have been filed against any of the doctors you are considering.” Pg. 4

    Learn more about the doctors you are considering

    Set up an appointment to meet and talk with the doctor you are considering and ask the following questions (you may think of more that are important to you).

    • Do you have many older patients?
    • How do you feel about involving my family in care decisions?
    • Can I call or email you or your staff when I have questions?
    • Do you charge for telephone or email time?
    • What are your thoughts about complementary or alternative treatments?

    When making a decision about which doctor to choose, you might want to ask yourself questions like:

    • Did the doctor give me a chance to ask questions?
    • Was the doctor really listening to me?
    • Could I understand what the doctor was saying? Was I comfortable asking him or her to say it again?

    Make the choice

    Once you choose your doctor remember to bring your medical records or make arrangements with your prior doctor to have them sent. You will need to sign a release of records form with them (make sure you bring your new doctor’s contact information).

    Next: How should I prepare?

    choosing your doctor 2

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  • March 17, 2014 /  Basics

    I will be referring almost exclusively to a free 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)

    https://permanent.access.gpo.gov/lps66054/TWYD_Final.pdf

    You can choose your doctor! Yes, that may sound obvious but I have clients who are unhappy with their current physician and didn’t realize they could switch. It is important that you find a doctor you can talk to without reservation. He or she will be the one who will eventually know you and what constitutes a “baseline” for your health. They can help you with medical decisions and can serve as the hub for all the other medical specialists and providers (kind of like a matriarch of the family or quarterback of a football team). The booklet states, “People sometimes hesitate to change doctors because they worry about hurting their doctor’s feelings. But doctors understand that different people have different needs. They know it is important for everyone to have a doctor with whom they are comfortable.” You should understand that this may take time but it is time well spent.

    The following is straight from the booklet.

    Decide what you are looking for in a doctor.

    “Do you care if your doctor is a man or a woman? Is it important that your doctor has evening office hours, is associated with a specific hospital or medical center, or speaks your language? Do you prefer a doctor who has an individual practice or one who is part of a group so you can see one of your doctor’s partners if your doctor is not available? After you have made your list, go back over it and decide which qualities are most important and which are nice, but not essential.”

    Identify several possible doctors

    Once you have a general sense of what you are looking for, ask friends and relatives, medical specialists, and other health professionals for the names of doctors with whom they have had good experiences. Rather than just getting a name, ask about the person’s experiences. For example: say, “What do you like about Dr. Smith?” and “Does this doctor take time to answer questions?” A doctor whose name comes up often may be a strong possibility. If you belong to a managed care plan—a health maintenance organization (HMO) or preferred provider organization (PPO)—you may be required to choose a doctor in the plan or else you may have to pay extra to see a doctor outside the network. Most managed care plans will provide information on their doctors’ backgrounds and credentials. Some plans have websites with lists of participating doctors from which you can choose.

    To be continued…

    choosing your doctor

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  • March 10, 2014 /  Basics

    In the following weeks I’ll be referring almost exclusively to a free 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)

    https://permanent.access.gpo.gov/lps66054/TWYD_Final.pdf

    They emphasize the importance of talking with your doctor as you get older. Why? “Partly because you may have more health conditions and treatments to discuss. It’s also because your health has a big impact on other parts of your life, and that needs to be talked about too.”

    Many times we go to the doctor knowing something but we don’t tell her/him. We expect them to find out/discover what “ails us” and from the doctor’s perspective, they figure you will tell them so all they will do is perform a normal checkup. Your relationship with your doctor should truly be more like a partnership.

    In addition to your primary care doctor, you should also develop a partnership with your pharmacist. While your doctor prescribes medication for you it is your pharmacist that can tell you not only the side effects but also if there could be an interaction with other medication you are taking.

    Next: Choosing a Doctor

    talking with doctor

    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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  • January 29, 2014 /  Resources

    I have been in a couple of seminars with Stephen teaching and he has a lot to share. He cares about those with special needs (he grew up in that environment) and is a very strong advocate for the whole community. He is also a big supporter of the Professional Fiduciaries’ Association of California (a group that supports training, mentoring and high ethics for fiduciaries) and those who just found out that there are responsibilities of being a trustee of a special needs trust or conservatorship.

    You can either click on this link http://dalelawfirm.com/  or go to my Special Needs Resources tab and then look up the link to the office and then go to the educational videos tab and begin learning!

    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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  • January 16, 2014 /  Resources

    I have been doing some more wandering around the worldwide web and have discovered some amazing resources. Please visit my resource page for the links connecting to these organizations.

    Family Caregiving Alliance, National Center on Senior Transportation.

    I have reorganized my resource page to incorporate a Special Needs section for families. It now includes ARC (which was previously listed elsewhere), Achieving Independence, and Special Needs Alliance.

    My resource page keeps growing so come back periodically and see what is new!

    resourceBooks

    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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  • December 10, 2013 /  Difficult Conversations

    Each of the 5 tips listed below are shared with us courtesy of Help Guide.org about effective tips when having this type of conversation with an aging loved one about driver safety, or possible confiscation of car keys. 

    • Be respectful. For many seniors, driving is an integral part of independence. Many older adults have fond memories of getting a driver’s license. At the same time, don’t be intimidated or back down if you have a true concern.

    • Give specific examples. It’s easier to tune out generalizations like “You just can’t drive safely anymore.” Outline concerns that you have noticed, such as “You have a harder time turning your head than you used to,” or “You braked suddenly at stop signs three times the last time we drove.”

    • Find strength in numbers. If more than one family member or close friend has noticed, it’s less likely to be taken as nagging. A loved one may also listen to a more impartial party, such as a doctor or driving specialist.

    • Help find alternatives. The person may be so used to driving that they have never considered alternatives. You can offer concrete help, such as researching transportation options or offering rides when possible. If your family member is reluctant to ask for help, it can lead to isolation and depression.

    • Understand the difficulty of the transition. Your loved one may experience a profound sense of loss having given up driving. Don’t dismiss their feelings but try to help with the transition as much as possible. If it is safe, try slowly transitioning the senior out of driving to give them time to adjust. For example, your loved one may begin the transition by no longer driving at night or on the freeways, or by using a shuttle service to specific appointments, such as the doctor’s. ~ Source: Help Guide.org

    This can be a difficult conversation for several reasons including sensitivity some aging loved ones might feel, or head strong aging relatives like Uncle Oscar who are used to having everything their way.

    Join our conversation and share with us any helpful tips and suggestions on what can make this sometimes dreaded conversation end with a favorable result.

    A friendly reminder is the week of December 2nd is National Older Driver Safety Awareness Week, so these helpful tips are ideal for future reference information.

    drivingkeys

    I serve the counties of El Dorado, Placer, Sacramento, Solano, Sutter, Yolo, and Yuba, as well as cities like Auburn, Lincoln, Rocklin, Roseville, Sacramento, Placerville, and Woodland.

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