The Doctor-Patient Relationship

There is nothing more special and sacred than the doctor-patient relationship.  I once had a physician professor in medical school with his loud, booming preacher-like voice say,

“There is something so remarkable about becoming a physician. You get to be present at their birth or at their death. You will witness the most fragile moments in a person’s life. You will see the naked for God's sake. Young Doctors, they trust you. Treat them well!”

In our world today, this type of relationship is fading, ever so slowly. Chipped away by more technology, more systematic approaches and less face to face time. When I have a moment with a patient that we truly connect on a deeply personal level, I treasure it. I love the diversity and age range of my practice. The term, “from cradle to grave,” was meant for a family doctor. All ages, every disease, each organ, individual treatment.

But wow, can it be overwhelming!

Unlike other physicians who dedicate their practice to one organ system or disease, family doctors care for the entire person. Where else can you go for an office visit, get a pelvic exam, prescription for allergy medication, talk about your family and want to come back? Your local family doctor that is!

So do you have a doctor in your life like this? If so, wonderful! I would recommend taking an active role in your health care. Here are some tips to work your your physician so together you can achieve the best health possible:

  • Talk to your doctor about any current or past health care issues (or make sure the nurse has your chart up to date)
  • Let them know what medicines you are taking INCLUDING any herbals, over the counter medications, vitamins, supplements, old medicines you have been saving back, etc
  • Create a health journal. This is simply keeping track of what doctors you see, what medicines you take, any allergies, advance directives, etc and keeping this all in a folder.
  • Ask questions. Let your doctor know when you don’t understand. If you don’t ask, we doctors typically assume you understood what we said.
  • Ask for information to take home. You can also bring someone along to take notes. Or if you don’t have an extra person, record the instructions from your doctor on your phone. I have had my patients make a quick video of me explaining a new medication or telling them important information.
  • Follow up with your doctor especially if you have confused or start to feel worse.

From familydoctor.org (patient portal provided by the American Academy of Family Physicians) states that research has shown that people who have an ongoing relationship with their primary care physician (also referred to as PCP) have better overall health outcomes, lower death rates and lower total costs of care. Sounds pretty darn good to me.

Be Well!

When does drinking become a problem? (Aging Parent Series)

The aging population is not immune to alcohol abuse.  For men and women 65 years of age or older, the National Institute on Alcohol Abuse considers one drink per day to be the maximum amount for “moderate” alcohol use. So “heavy drinking” is defined as having more than two drinks per day. Estimates show that 2-13% of individuals over the age of 60 suffer from alcoholism (1,2). Factors that make alcohol more problematic for this age group is that impairment can occur with less drinks consumed and many medical problems can be worsened by alcohol (gout , heart failure, hepatitis, etc).  

Alcohol use in the elderly predisposes them to falls, decreased judgment and cognition, pneumonia, poor nutrition and can worsen blood pressure issues. In older alcoholics, gastrointestinal disease, GI bleeding and stroke is more common. There is also a strong association with chronic alcohol abuse and head, neck and esophagus cancers. Alcohol also worsens depression which can be prevalent in this age group due to loss and grieving.

Diagnosing alcoholism can be more difficult with the elderly, particularly those that are retired or isolated because their drinking behaviors or negative consequences are not seen as regularly.

So what can you do for your loved one if you are worried about a drinking problem? Families have an important role in the treatment of alcoholism. The following steps were provided by the American Academy of Family Physicians for the role family members can take:

  • Seek medical attention for decline in patient's cognition or self-care.
  • Corroborate information on recent and lifetime drinking problems.
  • Participate if confrontation is needed.
  • Provide support during detoxification and chronic treatment
  • Assist in coordination with community services at home.
  • Make decisions for older alcoholics with impaired cognition who are unable to process information, weigh consequences or communicate decisions.
  1. Substance Abuse and Mental Health Services Administration. 2009. Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, Substance NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD.
  2. Mirand AL, Welte JW. Alcohol consumption among the elderly in a general population, Erie County, New York. Am J Public Health. 1996;86:978–84.


Fear of Falling (Aging Parent Series)

It’s more than “I’ve fallen and can’t get up!”

Falls are responsible for significant number of injuries, accidents, hospital admissions, surgeries, nursing home placements and even death in the 65+ crowd. If you fall and break a bone, it can be the start of an awful avalanche of problems.

Risk factors include problems with hearing, vision, walking and mobility. Also when acute illnesses happen, folks that already have chronic issues, tends to have more falls. Many medications can give side effects of drowsiness, dizziness and confusion. However when multiple medications are taken together, it increases the likelihood of falls tremendously. Ways that you can help your loved ones to decrease the chance of them falling are:

  • Encouraged your love one to stay active. Regular exercise improves muscle strength and slow bone loss.
  • Have their eyes and hearing tested. Even slight changes can make a big difference.
  • Improving lighting. Poorly lit areas mixed with poor vision leads to a dangerous situation. Make sure there is good lighting with light switches at both ends of a stairs or large room. Remember to use the lights.
  • Downsize big furniture. Obstructive furniture that has to be navigated around can become a trap when someone is rushing to the bathroom. Consider a new place for it or replacing with something smaller.
  • Slippery floors. The aging brain is not quite as quick at reacting to changes in position. Also aging bones tend to be more fragile, if not, osteoporotic. So a small slip could equal a big break. Consider placing slip guards or no-slip strips on tile or wood floors. Don’t wax floor surfaces. Clean up water immediately if spilled.
  • Loose floor covering. Loose throw rugs are a big no-no for the 65+ crowd. Consider either securing these or getting rid of them all together
  • Bathrooms without rails or grab bars. Bathrooms can be a sand trap for falls. They are the perfect storm: slippery surfaces, water and tight spaces. Even though it may not be the most fashionable, consider adding grab bars or railing in prominent areas in bathrooms for additional safety.
  • Talk you the doctor about any medications causing side effects.

Here are some helpful resources:
Eldercare Locatorwww.eldercare.gov
National Center for Injury Prevention and Control www.cdc.gov/ncipc
National Resource Center on Supportive Housing and Home Modifications
www.homemods.org


Also many state and local government bodies have education and home modification programs to help older people prevent falls. Check with your health department, senior center office or area agency on aging for more details.

Be Well!


When is it Time to Hang Up the Keys? (Aging Parent Series)

Remember the feeling of holding your first driver’s license in your hand. The Freedom! The Independence! You could go anywhere!

Now imagine of opposite, you are told you can no longer drive yourself and hand over your license. This is a situation that many older adults are facing and many fear the loss of independence and control that driving provides.

Normal aging does affect driving but there isn’t a “set age” when driving must stop.

When asked about driving safety, I generally reply back, “Would you feel comfortable letting your children/grandchildren ride in the car with this driver?” This usually gets the conversation started quickly!

As a physician, I take into account the following areas when assessing if driving is best for you:
Vision
With age comes a natural decline in vision so making sure your current prescription for glasses are accurate and YOU ARE WEARING THEM.  Seeing an ophthalmologist or optometrist should be at least an annual event for the 60+ crowd.
Physical Health
Are you falling? Do you have trouble moving your foot to the gas pedal /brake or turning the steering wheel? It takes flexibility, coordination and some strength to drive a car safely. Your doctor may recommend a formal driving course or occupational therapy if there is a concern about your physical strength. I have listed a few sites that offer Mature Driving Courses at the bottom. Usually car insurance companies will also discount drivers who participate in them as well!
Cognition
Driving requires quick decisions and a working memory. Adults with dementia, advanced medical issues or on medications that modify or slow your brain should have a more formal evaluation on their cognition.

Have you started to recognize some problems with someone’s driving? The following are some red flags from The Alzheimer’s Association and AAA that you should pay attention to:

  • Issued 2 or more traffic tickets in the past 2 years
  • Involved in 2 or more accidents or “near misses” or seem to always have new dings in their vehicle
  • The driver get confused with the pedals or has trouble working them
  • Seems to ignore or miss traffic signs and signals
  • Commonly weaves or straddles lanes
  • Gets lost or disoriented easily even with familiar places

Working together with your loved one and making a collective decision is best. Family Caregiver Alliance and National Institute on Aging (NIA) recommend the following steps when deciding when to stop

  • Involve the Driver: No one wants to be hoodwinked in this life-changing decision
  • Observe for Signs: Share and discuss your observations
  •  Build a Record: Don’t just tell someone they are a bad driver, have specific examples.
  • Get help from professionals: DMV with driving test, person’s physician, lawyer, case manager, finance planner, etc can give an unbiased, third party opinion for guidance.
  • Develop a Plan: This could mean limit driving by having “certain rules” to follow or decide how to transition out of driving
  • Find Alternatives: Public transportation, taxi service, relying on friends or family.
  • Reduce the Need to Drive: Look for services that drop off at the person’s home or make home visits (pharmacies, hairdressers, clergy, groceries, etc)

Much of the information in this blog was gathered from National Highway Traffic Safety Administration’s Driving Safely While Aging Gracefully Campaign, The American Automobile Association (AAA) and several resources listed within the article and below.

For Older Drivers, have an open and honest talk with your doctor or loves ones if you are concerned about your driving. We all just want to help!
Be Well!


Resources
http://seniordriving.aaa.com
www.alz.org
https://caregiver.org/dementia-driving
http://www.nia.nih.gov/alzheimers/features/tips-caregivers-when-driving-should-stop

Mature Driver Education Classes
AAA Mature Driver Program
Take the on-line course or call your local AAA club or 1-800-448-7916
A great brochure: Flexibility Fitness from AAA: Flexibility Fitness Training for Improving Older Driver Performance (available on website)


AARP Driver Safety Program (formerly known as "55 Alive")
AARP Smart Driver Course
1-800-350-7025


Caring for Aging Parents Introduction

Multi-Part Series on our Super Seniors

People 65 yrs+ numbered 43.1 million (or about 1 in every 7 Americans) in 2012. The estimations are that by 2030,that number will about DOUBLE to 72.1 million. There’s nothing magical about the number 65. You don’t get a crown or a box of gold on your sixty-fifth birthday but there are differences that do occur in your body, home environment, relationships and more. I want to discuss sensitive subjects that tend to be swept under the rug; Falls, Alcohol Abuse in Elderly, Driving, Sexuality, Care Provider burn-out, Final wishes and more.

This will actually be a several part series.  Check back often for updates!

While you are waiting, here are some great resources to explore…
www.nia.nih.gov
www.aoa.gov
www.healthinaging.org
www.cms.gov
www.medicare.gov
www.caps4caregivers.org
www.eldercare.gov
www.caregiver.org
www.familycaregiving101.org
www.pace4you.org
www.wellspouse.org
www.nhpco.org


Be Well!

 

Stressed To The MAX--Why managing stress matters

Some cook. Some hide. Some cry. Some drink. Some eat. Some shop. Some pray. We all handle stress in different ways.  But are you really coping with stress or just managing the symptoms it creates?

What Happens To Your Body When You Are Stressed?
Stress is a process in which we react in specific ways to external or internal stressors. Our bodies naturally release hormones called catecholamines that historically would enhance survival and adaptive responses. If a huge bear is chasing you, you would run, make quick decisions, even ignore broken bones to survive because of the catecholamine surge. However, as society has advanced, we no longer have the need to run away from bears. Instead, we constantly are battling other types of stress that can still be damaging. With prolonged stress, our bodies continue to release high concentrations of stress hormones (catecholamines but also substances called prostaglandins and corticosteroids). This negatively alters the immune system, causes chronic muscle tension, and generates an imbalance in many organ groups (especially cardiovascular, nervous and endocrine systems).

What If Stress Isn’t Handled Appropriately?
Emotional and mental stress will evidently manifest physically, here’s how:  the initial reaction to stress is alarm and awareness of the stress (this is when your body starts that catecholamine surge). The next step is typically an attempt to cope or problem-solve the stress. We tend to try to use all our resources to meet and overcome. If successful, we learn from the experience and the stress process stops. If not successful, we tend to become completely spent emotionally, mentally and physiologically. This leads to the last stage, exhaustion. This is where I tend to find people coming into my office. Their emotional and physical reserves are depleted. They are searching for help, not for their stress but instead for the symptoms caused by prolonged stress.

They tend to tell me about the following:

  • Weight gain or loss
  • Upset stomach
  • Stiff neck or jaw
  • Shortness of breath
  • Relationship problems
  • Trouble sleeping or insomnia
  • High blood pressure
  • Increase in Headaches or new onset headaches
  • Fatigue
  • Depressed mood
  • Constipation or diarrhea
  • Back pain
  • Anxious thoughts
  • Increased smoking
  • Drug use
  • Drinking alcohol

Are you currently experiencing any of the following? If so, maybe it’s time to evaluate your stress level!

Dealing With Stress
There are only two ways to change your stress level:

  1. Change the stress

This means getting rid of whatever is causing stress. Is there something in your life like an abusive relationship, job dissatisfaction, family dispute? Please gather up the courage and say “I HAVE HAD ENOUGH!”  Make a change to resolve these problem areas.

  1. Change your response to stress

For most of us, our stressors cannot be changed. Chronic illness, recent death, unavoidable changes that occur in life, the list goes on and on. These are unavoidable causes of stress so you must change your response to stress. A buzz word that flies around is “self-care.” This involves taking an internal look at yourself, realizing how you react to a situation and how you can modify this. Think about how the stress makes you feel and think. You control your thoughts and your reactions. You can change your reaction.

Stress Management Techniques
Get Support
A powerful tool to managing stress is having a support system. As humans, we were made to be a part of group. Seek out the significant people in your life who provide love, a sense of belonging and trust then ask if you can share your feelings with them.  This may involve getting more involved with your church family, local community group or close network of friends. Over 200 medical studies have proven that people who regularly participate in groups that provide comfort and support have better health outcomes and longer life expectancy.

Gain a Sense of Control by Relaxing and Rethinking your Thoughts
Many experience increased stress because they fear or worry about the unknown. They overthink the situation and create a falsehood of “worsening doom.” Instead clearly outline what is making you feel stressed. Think about what will likely happen then ask yourself, “Can I change the outcome?” If the answer is no, then ask, “how can I react to this?” The technical term for this called “behavior rehearsing” or “cognitive behavior therapy.”

Get Some Sleep
Many people describe “not being able to turn their thoughts off” or “lying in bed worrying.” Though insomnia is not a life threatening problem, it does lead to poor daytime performance, worsening depression or anxiety and continues to escalate the stress process. Before you jump to sleep aid medications, try the following sleep habits

  • Exercise regularly
  • Avoid caffeine, nicotine, alcohol, excessive warmth and hunger around bedtime
  • Go to bed only when sleepy
  • Don’t lay in bed watching TV or using your cell phone
  • Get up about the same day regardless of when you go to bed
  • When you lay down, try to relax all your muscle particularly your neck, shoulders and face. Deep breathe slowly and evenly.
  • If you go to bed and don’t fall asleep in 20 minutes, get back up and return to bed when sleepy.


Be Well!