Senior Health Associates

Geriatric Medical Care for South Carolina’s Seniors

(803) 699-9073

You've Come to The Right Place

Senior Health Associates is South Carolina’s leading provider of home based geriatric primary care.  We take an active approach to our patients’ health looking for ways to prevent illness and keep our patients functioning at the highest possible level.

Our providers are board certified in Geriatrics, Internal Medicine, Family Medicine, Hospice and Palliative Care.

Seniors have unique characteristics that differentiate them from younger populations. The majority of health care practitioners caring for older patients have not been adequately trained.  As a result, many practitioners treat an 85 year old patient in the same manner as a 50 year old patient – despite the remarkable differences between these patient populations.

Too often, illnesses in older adults are misdiagnosed, overlooked or dismissed as the normal process of aging simply because many health care professionals are not trained to recognize how diseases and drugs affect older patients differently than younger patients.

people, old, man

About

Senior Health Associates is collaborative group practice which was opened in the Midlands in 1999 by Dr. Keith Guest following completion of his Geriatric Fellowship at Palmetto Richland. Since that time we have provided in home care to over 5000 patients, in over 50 facilities. We are the largest provider of home based geriatric care in South Carolina. Our providers are board certified in Geriatrics, Internal Medicine, Family Medicine, Hospice and Palliative Care.

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Medical Care

Our practice often encounters common geriatric conditions that can prove quite challenging to individuals without geriatric training.  It is not unusual for our patients to present with unexplained complaints of fatigue, weakness, confusion, or delirium.

 Many times this is due to polypharmacy (multiple drug usage). Patients are very often taking one medicine to treat the side effects of another medicine. This approach will only work for so long before larger problems begin.

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  • Hip Fractures
  • Restless Legs Syndrome
  • Deep Vein Thrombosis
  • Arthritis
  • Deep Vein Thrombosis
  • Osteoporosis
  • Menopause: What to Expect When Your Body is Changing
  • Urinary Incontinence
  • Kegel Training
  • Bladder Training
  • Fecal Incontinence
  • Constipation

New Patients

Please return completed NEW PATIENT FORMS to our office.  We will notify you when the forms are received and again after we have processed the forms and determined our capacity to accept you into our practice.  This process normally takes 72 hours.  After you have been accepted in our practice, our providers will usually schedule your appointment during their next regularly schedule visit to your facility as time allows or they will call you to schedule a visit if you are living at home.
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Grieving: Facing Illness, Death and Other Losses

What is grief?

Grief is a normal, healthy response to loss. One of the greatest losses that can occur is the death of someone you love. Other losses include the loss of your health or the health of someone you care about, or the end of an important relationship, such as a marriage. Healing from a loss involves coming to terms with the loss and the meaning of the loss in your life.

What are the normal feelings of grief?

  • Anger
  • Blaming yourself
  • Crying spells
  • Diarrhea
  • Dizziness
  • Fast heartbeat
  • Feeling like there’s a lump in your throat
  • Feeling like what’s happening around you isn’t real
  • Headaches
  • Hyperventilating — sighing and yawning
  • Nausea
  • Not being able to get organized
  • Not feeling hungry or losing weight
  • Restlessness and irritability
  • Sadness or depression
  • Seeing images of the dead person
  • Shortness of breath
  • Tightness in your chest
  • Tiredness
  • Trouble concentrating
  • Trouble sleeping
As you face a loss, you may have different feelings at different times. These feelings include shock, denial, anger, guilt, sadness and acceptance. You may find yourself going back and forth from one feeling to another. For example, right when it seems that you’re starting to accept your loss, you may find yourself feeling sad or guilty again. Your grief may never completely go away. But the pain you feel will lessen with time as you work through these feelings.

What usually happens first?

In the first hours or days after the loss, you may feel shocked, numb and confused. You may not remember what people have said to you. You may think and act as though the loss hasn’t occurred. This is called denial.

As the shock wears off, reality will slowly break through. You’ll begin to realize that the loss has happened. It’s normal to feel abandoned and angry. You may direct your anger toward God, religion, doctors and nurses, the one who has died or other loved ones, or even yourself.

What happens after the anger wears off?

After you get through some of the anger and denial, it’s normal to pretend things are like they used to be. If someone you love has died, you may play memories over and over in your mind. You may also feel the presence of your loved one, think you see him or her, or think you hear his or her voice.

You may also find yourself talking to your loved one as though he or she were in the room with you. As you begin to realize that your loved one is gone and won’t be back, you’ll begin to feel the full impact of your loss. These feelings may be scary because they’re so strange and so strong. They may make you feel like you’re losing control.

What happens then?

When you begin to realize the full impact of the loss on your life, you may feel depressed and hopeless. You may also feel guilty. You may find yourself thinking things like “if only” or “why me?” You may cry for no apparent reason. This is the most painful stage of healing, but it won’t last forever. In normal grief, the depression will begin to lift with time.
 

What is the first sign of relief?

You may start to feel better in small ways. For example, you may find it’s a little easier to get up in the morning, or you may have small bursts of energy. This is the time when you’ll begin to reorganize your life around your loss or without your loved one.

What is the final stage?

Tips on dealing with a loss

  • Talk about how you’re feeling with others.
  • Try to keep up with your daily tasks so you don’t feel overwhelmed.
  • Get enough sleep, eat a well-balanced diet and exercise regularly.
  • Avoid alcohol. Alcohol can make you feel more depressed.
  • Get back into your normal routine as soon as you can.
  • Avoid making major decisions right away.
  • Allow yourself to grieve–to cry, to feel numb, to be angry or to feel however you’re feeling.
  • Ask for help if you need it.
The last stage of accepting a loss is when you begin to reinvest in other relationships and activities. During this time, it’s normal to feel guilty or disloyal to your loved one because you’re moving on to new relationships. It’s also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays and during other special times.

How long does grief last?
You’ll probably start to feel better in 6 to 8 weeks. The whole process can last anywhere from 6 months to 4 years.

If you feel like you’re having trouble at any point, ask for help. People who can help include friends, family, clergy, a counselor or therapist, support groups and your family doctor.

Be sure to talk with your family doctor if you have a lot of trouble eating, sleeping or concentrating for more than the first couple of weeks. These can be signs of depression. Your family doctor can help you with depression so you can start to feel better.

Glaucoma

What is glaucoma?

Glaucoma is an eye disease that may cause loss of vision. It occurs as a result of a buildup of fluid in the eyeball. The fluid nourishes your eye and keeps it healthy. After the fluid circulates, it empties through a drain in the front of your eye. In people with glaucoma, the drain in the eye is blocked and the fluid can’t run out of the eyeball. Instead, the fluid builds up and causes increased pressure in the eye.
 

How does increased pressure damage your eye?

The increased pressure destroys the nerve cells in the eye, which leads to vision loss. At first, you may have blind spots only in your peripheral, or side, vision. If your glaucoma isn’t treated, your central vision will also be affected. Vision loss caused by glaucoma is permanent.
 

What are the symptoms of glaucoma?

Most people who have glaucoma don’t have any symptoms. You might not realize that you’re losing vision until it’s too late. Half of all people with loss of vision caused by glaucoma are not aware they have the disease. By the time they notice loss of vision, the eye damage is severe.

Rarely, an individual will have an acute (sudden or short-term) attack of glaucoma. In these cases, the eye becomes red and extremely painful. Nausea, vomiting and blurred vision may also occur.

Who gets glaucoma?

Risk factors for glaucoma include older age, black race, family history of glaucoma, high pressure in the eyes, diabetes, hypertension and near-sightedness.
 

How do I know if I have glaucoma?

You won’t know you have glaucoma until you notice vision loss. Since glaucoma causes no symptoms other than vision loss, it is important that you have a complete eye exam by an ophthalmologist regularly. An ophthalmologist is a doctor who is trained to provide care for the eyes, including the diagnosis and treatment of glaucoma. Your ophthalmologist can measure your eye pressure, examine your optic nerve and evaluate your central and peripheral vision. Early diagnosis and treatment of glaucoma can prevent damage to the eye’s nerve cells and prevent vision loss.
 

How often should I have an eye exam?

It is generally recommended that you have a complete eye exam by age 39. After that, eye exams should be done every 2 to 4 years. After age 64, they should be done every 1 to 2 years.
 

What is the treatment for glaucoma?

Glaucoma can be treated with eyedrops, pills, laser surgery, eye surgery or a combination of methods. The purpose of treatment is to lower the pressure in the eye so that further nerve damage and vision loss are prevented.

Blood Pressure Medicines

How is high blood pressure treated?

High blood pressure medicines (also called antihypertensive medicines) can help lower your blood pressure. The goal of treatment is to reduce your blood pressure to normal levels with medicine that is easy to take and has few, if any, side effects. Your doctor may also talk to you about the benefits of lifestyle changes, such as eating a healthy diet, being physically active, and losing weight if you’re overweight.
 

What are some common medicines to treat high blood pressure?

There are 8 types of medicine used to treat high blood pressure. Your doctor will decide which type of medicine is right for you.

Diuretics (water pills) help your body get rid of extra sodium (salt) and water so your blood vessels don’t have to hold so much fluid. Some examples of diuretics include chlorthalidone (brand name: Thalitone), furosemide (brand name: Lasix), hydrochlorothiazide (brand name: Esidrix) and indapamide (brand name: Lozol). Your doctor may also prescribe a combination of diuretics, such as hydrochlorothiazide combined with triamterene (brand names: Dyazide, Maxzide).

Beta-blockers make the heart beat slower so that blood passes through your blood vessels with less force. Some examples of beta-blockers include acebutolol (brand name: Sectral), atenolol (brand name: Tenormin), carvedilol (brand name: Coreg), metoprolol (brand names: Lopressor, Toprol XL), nadolol (brand name: Corgard), propranolol (brand name: Inderal) and timolol (brand name: Blocadren).

Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) keep your body from making angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ACE inhibitors include benazepril (brand name: Lotensin), enalapril (brand name: Vasotec), lisinopril (brand names: Prinivil, Zestril), quinapril (brand name: Accupril), ramipril (brand name: Altace) and trandolapril (brand name: Mavik).

Angiotensin II receptor blockers (also called ARBs) protect your blood vessels from the effects of angiotensin II, a hormone that causes blood vessels to narrow. Some examples of ARBs include candesartan (brand name: Atacand), irbesartan (brand name: Avapro), losartan (brand name: Cozaar), olmesartan (brand name: Benicar), telmisartan (brand name: Micardis) and valsartan (brand name: Diovan).

Calcium channel blockers (also called CCBs) help keep your blood vessels from constricting (becoming narrow) by blocking calcium from entering your cells. Some examples of CCBs include amlodipine (brand name: Norvasc), diltiazem (brand names: Cardizem, Cartia, Dilacor, Tiazac), felodipine (brand name: Plendil), nicardipine (brand name: Cardene), nifedipine (brand names: Adalat, Procardia) and verapamil (some brand names: Calan, Covera, Isoptin, Verelan).

Alpha-blockers help relax your blood vessels by reducing nerve impulses. This allows your blood to pass through more easily. Some examples of alpha-blockers include doxazosin (brand name: Cardura), prazosin (brand name: Minipress) and terazosin (brand name: Hytrin).

Centrally acting drugs affect your brain and central nervous system to reduce the nerve impulses that can cause your blood vessels to narrow. Some examples of centrally acting drugs include clonidine (brand name: Catapres) and methyldopa.

Direct vasodilators relax the muscles in the blood vessel walls. This causes the blood vessels to widen. Some examples of vasodilators include hydralazine (brand name: Apresoline) and minoxidil (brand name: Loniten).

Do these medicines have any side effects?

Like most medicines, high blood pressure drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often. Some common side effects of high blood pressure medicines include the following:

 
  • Headache
  • Dizziness or lightheadedness
  • Nausea and/or vomiting
  • Extreme tiredness, weakness, drowsiness or lethargy (lack of energy)
  • Diarrhea or constipation
  • Weight loss or weight gain
  • Nervousness or increased anxiety
  • Chest pain, heart palpitations (the feeling that your heart is racing) or arrhythmia (irregular heartbeat)
  • Cough, fever, congestion, upper respiratory tract infection or “flu-like” symptoms
  • Skin rash
 
Tell your doctor as soon as possible if your side effects become severe or bothersome.

What is a drug interaction?

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a “drug-drug interaction.” Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a “drug-food interaction.” For example, people taking certain CCBs may need to avoid having grapefruit or grapefruit juice.

Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking.

Also, ask your doctor whether you need to avoid any foods or drinks while using your blood pressure medicine.

Parkinson's Disease

What is Parkinson's disease?

Parkinson’s is a disease that causes a progressive loss of nerve cell function in the part of the brain that controls muscle movement. Progressive means that this disease’s effects get worse over time.
 

What are the symptoms of Parkinson's disease?

People who have Parkinson’s disease experience tremors or shaking as a result of the damage to their nerve cells. Tremors caused by Parkinson’s get worse when the person is at rest and better when the person moves. The tremor may affect one side of the body more than the other, and can affect the lower jaw, arms and legs. Handwriting may also look “shaky” and smaller than usual. Other symptoms of Parkinson’s disease include nightmares, depression, excess saliva, difficulty walking or buttoning clothes, or cutting food.
 

How is Parkinson's disease diagnosed?

A doctor may diagnose a person with Parkinson’s disease based on the patient’s symptoms and medical history. No blood tests or x-rays can show whether a person has Parkinson’s disease. However, some kinds of x-rays can help your doctor make sure nothing else is causing your symptoms. If symptoms go away or get better when the person takes a medicine called levodopa, it’s fairly certain that he or she has Parkinson’s disease.
 

What causes Parkinson's disease?

Doctors don’t know exactly what causes Parkinson’s disease. They do know some medicines can cause or worsen symptoms of Parkinson’s disease. However, symptoms often disappear when the patient stops taking the medicines.
 

Can medicines treat Parkinson's disease?

There is no cure for Parkinson’s disease. But medicines can help control the symptoms of the disease. Some of the medicines used to treat Parkinson’s disease include carbidopa-levodopa (one brand name: Sinemet), bromocriptine (brand name: Parlodel), selegiline (one brand name: Eldepryl), pramipexole (brand name: Mirapex), ropinirole (brand name: Requip), and tolcapone (brand name: Tasmar). Your doctor can recommend the best treatment for you.

Sexual Dysfunction in Women

What is sexual dysfunction?

When you have problems with sex, doctors call it “sexual dysfunction.” Both men and women can have it. There are 4 kinds of sexual problems in women.
  • Desire disorders ­- When you are not interested in having sex or have less desire for sex than you used to.
  • Arousal disorders ­- When you don’t feel a sexual response in your body or you cannot stay sexually aroused.
  • Orgasmic disorders ­- When you can’t have an orgasm or you have pain during orgasm.
  • Sexual pain disorders ­- When you have pain during or after sex.

What causes sexual dysfunction?

Many things can cause problems in your sex life. Certain medicines (such as oral contraceptives and chemotherapy drugs), diseases (such as diabetes or high blood pressure), excessive alcohol use or vaginal infections can cause sexual problems. Depression, relationship problems or abuse (current or past abuse) can also cause sexual dysfunction.

You may have less sexual desire during pregnancy, right after childbirth or when you are breastfeeding. After menopause many women feel less sexual desire, have vaginal dryness or have pain during sex due to a decrease in estrogen (a hormone in the body).

The stresses of everyday life can also affect your ability to have sex. Being tired from a busy job or caring for young children may affect your sexual desire. You may also be bored by a long-standing sexual routine.

How do I know if I have a problem?

Up to 70% of couples have a problem with sex at some time in their relationship. Most women will have sex that doesn’t feel good at some point in her life. This doesn’t necessarily mean you have a sexual problem.

If you don’t want to have sex or it never feels good, you might have a sexual problem. Discuss your concerns with your doctor. Remember that anything you tell your doctor is private and that your doctor can help you find a reason and possible treatment for your sexual dysfunction.

What can I do?

If desire is the problem, try changing your usual routine. Try having sex at different times of the day, or try a different sexual position.

Arousal disorders can often be helped if you use a vaginal cream or sexual lubricant for dryness. If you have gone through menopause, talk to your doctor about taking estrogen or using an estrogen cream.

If you have a problem having an orgasm, you may not be getting enough foreplay or stimulation before actual intercourse begins. Extra stimulation (before you have sex with your partner) with a vibrator may be helpful. You might need rubbing or stimulation for up to an hour before having sex. Many women don’t have an orgasm during intercourse. If you want an orgasm with intercourse, you or your partner may want to gently stroke your clitoris. Masturbation may also be helpful, as it can help you learn what techniques work best for you.

If you’re having pain during sex, try different positions. When you are on top, you have more control over penetration and movement. Emptying your bladder before you have sex, using extra lubrication or taking a warm bath before sex all may help. If you still have pain during sex, talk to your doctor. There are a variety of causes of pain during sex, so talk with your doctor. He or she can help you find the cause of your pain and decide what treatment is best for you.

Can medicine help?

If you have gone through menopause or have had your uterus and/or ovaries removed, taking the hormone estrogen may help with sexual problems. If you’re not already taking estrogen, ask your doctor if this is an option for you.

You may have heard that taking sildenafil (Viagra) or the male hormone testosterone can help women with sexual problems. There have not been many studies on the effects of Viagra or testosterone on women, so doctors do not know whether these things can help or not. Both Viagra and testosterone can have serious side effects, so using them is probably not worth the risk.

What else can I do?

Learn more about your body and how it works. Ask your doctor about how medicines, illnesses, surgery, age, pregnancy or menopause can affect sex.

Practice “sensate focus” exercises where one partner gives a massage, while the other partner says what feels good and requests changes (example: “lighter,” “faster,” etc.). Fantasizing may increase your desire. Squeezing the muscles of your vagina tightly (called Kegel exercises) and then relaxing them may also increase your arousal. Try sexual activity other than intercourse, such as massage, oral sex or masturbation.

What about my partner?

Talk with your partner about what each of you like and dislike, or what you might want to try. Ask for your partner’s help. Remember that your partner may not want to do some things you want to try, and you may not want to try what your partner wants. You should respect each other’s comforts and discomforts. This helps you and your partner have a good sexual relationship. If you feel you can’t talk to your partner, your doctor or a counselor may be able to help you.

If you feel like your partner is abusing you, tell your doctor.

How can my doctor help?

Your doctor can suggest ways to treat your sexual problems or can refer you to a sex therapist or counselor if needed.

Erectile Disfunction (ED)

What is erectile dysfunction?

When a man can’t get an erection to have sex or can’t keep an erection long enough to finish having sex, it’s called erectile dysfunction or impotence. Erectile dysfunction can occur at any age, but it is more common in men older than 65.

Physical causes of erectile dysfunction

  • Alcohol and tobacco use
  • Fatigue
  • Brain or spinal-cord injuries
  • Hypogonadism (which leads to lower testosterone levels)
  • Liver or kidney failure
  • Multiple sclerosis
  • Parkinson’s disease
  • Radiation therapy to the testicles
  • Stroke
  • Some types of prostate or bladder surgery
 
Erectile dysfunction doesn’t have to be a part of getting older. It’s true that as you get older, you may need more stimulation (such as stroking and touching) to get an erection. You might also need more time between erections. But older men should still be able to get an erection and enjoy sex.

What causes erectile dysfunction?
See the box to the right for some physical causes of erectile dysfunction. The following medical problems can also cause erectile dysfunction:

 
  • Diabetes (high blood sugar)
  • Hypertension (high blood pressure)
  • Atherosclerosis (hardening of the arteries)
 
If you can’t keep your blood sugar or your blood pressure under control, you can get erectile dysfunction. It’s important that you take your medicines for these problems just the way your doctor tells you.

Sometimes your hormones get out of balance and this causes erectile dysfunction. Your doctor will decide if you need blood tests to check your hormones.

Some medicines can cause erectile dysfunction. If this is true for you, your doctor may take you off that medicine or give you a different one.

Drinking too much alcohol, smoking too much and abusing drugs can also cause erectile dysfunction.

Problems in your relationship with your sexual partner can also cause erectile dysfunction. Improving your relationship may help your sex life. If you decide to seek therapy, it will probably be most effective if your sex partner is included. Couples can learn new ways to please one another and to show affection. This can reduce anxiety about having erections.

Feelings that can lead to erectile dysfunction

  • Feeling nervous about sex, perhaps because of a bad experience or because of a previous episode of impotence
  • Feeling stressed, including stress from work or family situations
  • Being troubled by problems in your relationship with your sex partner
  • Feeling depressed
  • Feeling so self-conscious that you can’t enjoy sex
  • Thinking that your partner is reacting negatively to you

How is erectile dysfunction diagnosed?

Your doctor will probably start by asking you some questions and doing a physical exam. Samples of your blood and urine may be tested for diseases and disorders. Other tests may also be needed. Your doctor will determine which tests are right for you.

How is erectile dysfunction treated?

How erectile dysfunction is treated depends on what is causing it. After your doctor checks you for medical problems and medicines that might cause erectile dysfunction, he or she may have you try a medicine to help with erectile dysfunction. Some of these medicines are injected into your penis. Other medicines are taken by mouth. Not everyone can use these medicines. Your doctor will help you decide if you can try them.

What other options do I have?

If the medicines aren’t right for you, you could also try using vacuum pump devices, or you could have surgery. Your doctor may send you to an urologist to talk about these options.

Prostate Cancer

What is the prostate gland?

The prostate gland is part of the male reproductive system (see the picture below). The prostate makes a fluid that mixes with sperm and other fluids during ejaculation. A normal prostate is about the size of a walnut.

What is prostate cancer?

The body is made up of many types of cells. Normally, cells grow, divide and then die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than dying, these abnormal cells clump together to form tumors. If these tumors are cancerous (also called malignant tumors), they can invade and kill your body’s healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, noncancerous tumors (also called benign tumors) do not spread to other parts of the body. Prostate cancer is abnormal cells in the prostate gland.

Like many types of cancer, prostate cancer can be aggressive. This means it grows quickly and can spread to other parts of the body. (When cancer spreads, doctors say the cancer has “metastasized.”) Prostate cancer can also grow more slowly.

If you have prostate cancer, it is important for your doctor to monitor the growth of your cancer carefully. If left completely unchecked, the cancer can grow quickly and spread to other organs in your body. This makes treatment much more difficult.

Who is at risk for prostate cancer?

Prostate cancer is the most common type of cancer found in American men, other than skin cancer.

Although men of any age can get prostate cancer, it is found most often in men over age 50. In fact, more than 8 of 10 men with prostate cancer are over the age of 65.

For unknown reasons, African-American men are at higher risk than Caucasian men. Men with a family history of prostate cancer are at higher risk, too. In this case, family history means that your father or a brother had prostate cancer.

Men who are obese and eat a diet high in fat are also at a higher risk for prostate cancer.

How does my doctor check my prostate?

Your doctor may examine your prostate by putting a gloved, lubricated finger a few inches into your rectum to feel your prostate gland. This is called a digital rectal exam. A normal prostate feels firm. If there are hard spots on the prostate, your doctor may suggest additional testing to check for prostate cancer.
 

What is the PSA test?

Another way to check for prostate cancer is with a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of less serious causes, such as infection.
 

Possible Symptoms of Prostate Cancer

Prostate cancer, especially in its early stages, often does not have any symptoms. Symptoms are more likely to appear as the cancer grows.

Call your doctor if you have any of these symptoms:
 
  • Difficulty starting to urinate
  • Less force to the stream of urine
  • Dribbling after you finish urinating
  • Frequent urination, especially at night
  • Blood or pus in the urine
  • Pain while urinating
  • Pain with ejaculation
  • Hip and lower back pain that does not go away over time
  • Pain in the lower part of your pelvis
  • Unintended weight loss and/or loss of appetite

What are the treatment options for prostate cancer?

If prostate cancer is caught early and before it has spread to other parts of the body, it can often be treated successfully.

For early stages of prostate cancer, one option is “watchful waiting.” Watchful waiting means seeing your doctor often so he or she can track the cancer. This can include frequent blood tests and rectal exams to check the growth of the cancer. This may be a good option for those with slow-growing cancer, or men who are elderly and/or in poor health. At any time during watchful waiting, you can choose to switch to another treatment.

It is important to realize that watchful waiting does not involve medication or treatment that will kill the cancer. It is just an observation period. If the cancer suddenly starts to grow more quickly or begins to cause symptoms, you may need to switch to a more aggressive treatment option.

Surgery, radiation and drug therapy are options that can treat your prostate cancer. These treatments can cause side effects, such as impotence and incontinence, but these side effects usually disappear after treatment.

Memory Loss With Age: Whar's Normal, What's Not

How does the brain store information?

Information is stored in different parts of your memory. Information stored in the short-term memory may include the name of a person you met moments ago. Information stored in the recent memory may include what you ate for breakfast. Information stored in the remote memory includes things that you stored in your memory years ago, such as memories of childhood.
 

How does aging change the brain?

When you’re in your 20s, you begin to lose brain cells a few at a time. Your body also starts to make less of the chemicals your brain cells need to work. The older you are, the more these changes can affect your memory.

Aging may affect memory by changing the way the brain stores information and by making it harder to recall stored information.

Your short-term and remote memories aren’t usually affected by aging. But your recent memory may be affected. For example, you may forget names of people you’ve met recently. These are normal changes.

Things to help you remember

  • Keep lists.
  • Follow a routine.
  • Make associations (connect things in your mind), such as using landmarks to help you find places.
  • Keep a detailed calendar.
  • Put important items, such as your keys, in the same place every time.
  • Repeat names when you meet new people.
  • Do things that keep your mind and body busy.
  • Run through the ABC’s in your head to help you think of words you’re having trouble remembering. “Hearing” the first letter of a word may jog your memory.

What about when I know a word but can't recall it?

This is usually just a glitch in your memory. You’ll almost always remember the word with time. This may become more common as you age. It can be very frustrating, but it’s not usually serious.
 

What are some other causes of memory problems?

Many things other than aging can cause memory problems. These include depression, dementia (severe problems with memory and thinking, such as Alzheimer’s disease), side effects of drugs, strokes, head injury and alcoholism.
 

How does Alzheimer's disease change memory?

Alzheimer’s disease starts by changing the recent memory. At first, a person with Alzheimer’s disease will remember even small details of his or her distant past but not be able to remember recent events or conversations. Over time, the disease affects all parts of the memory.
 

How can I tell if my memory problems are serious?

A memory problem is serious when it affects your daily living. If you sometimes forget names, you’re probably okay. But you may have a more serious problem if you have trouble remembering how to do things you’ve done many times before, getting to a place you’ve been to often, or doing things that use steps, like following a recipe.

Another difference between normal memory problems and dementia is that normal memory loss doesn’t get much worse over time. Dementia gets much worse over several months to several years.

It may be hard to figure out on your own if you have a serious problem. Talk to your family doctor about any concerns you have. Your doctor may be able to help you if your memory problems are caused by a medicine you’re taking or by depression.

Memory problems that aren't part of normal aging

  • Forgetting things much more often than you used to
  • Forgetting how to do things you’ve done many times before
  • Trouble learning new things
  • Repeating phrases or stories in the same conversation
  • Trouble making choices or handling money
  • Not being able to keep track of what happens each day

CPAP Devices for sleep apnea

What is sleep apnea?

In some people, the windpipe that brings air into the body is blocked during sleep. This keeps the lungs from getting enough air. This is called obstructive sleep apnea. People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping. These stops can happen up to 400 times every night. The consequences of these disturbances can be serious and sometimes life-threatening.
 

What is a CPAP device?

One way to treat people who have sleep apnea is a continuous positive airway pressure (CPAP) device. A CPAP device includes a mask, tubes and a fan. It uses air pressure to push your tongue forward and open your throat. This allows air to pass through your throat. It reduces snoring and prevents apnea disturbances.

You should put your CPAP device on whenever you sleep, even for naps. A CPAP device does not cure sleep apnea. But, when you use the device correctly, your sleep problems should get much better.

Do I need a CPAP device?

Talk to your doctor if you think you have sleep apnea. Your doctor may ask you to go to a sleep center for a sleep study. During your sleep study, you may try different levels of air pressure with a CPAP device to see which level helps. In general, heavier people and people who have severe apnea need higher air pressures. If you need a CPAP device, your doctor will help you choose one that is right for you.
 

What if I have problems with my CPAP device?

Many people have problems with their CPAP device, especially at first. Don’t give up. Often, the problems go away when you get used to wearing the device. It may also be helpful for you to find a support group in your area so that you can talk with other people who also have sleep apnea.

The following are some common problems you may have with your CPAP device, and some possible solutions:
  • The mask feels uncomfortable. Because everyone’s face has a different shape, you may need to try different masks to find one that fits you well.
  • Your nose feels dry and stuffy. You can try using a humidifier to moisten the air from the CPAP device.
  • Your nose feels blocked up. Some people who have sleep apnea also have nose problems. Ask your doctor if you have a nose problem that can be treated with a nasal spray. Surgery is sometimes also an option. People who breathe through their mouths don’t do as well with CPAP nose masks. In this case, a full-face mask that covers both the nose and the mouth may help (see the picture below).
  • The mask bothers your skin and nose. Because the mask must fit firmly over your nose and cheeks, it may irritate your skin. A different size or kind of mask may help. There are also special skin moisturizers made for CPAP device users. Some petroleum-based products can damage the mask, so ask your doctor for more information. Some people also benefit from using nasal pillows that fit into the nostrils and relieve pressure on the bridge of the nose (see the picture below). Using a regular CPAP mask one night and nasal pillows the next night may help you feel more comfortable.
  • The mask leaks air. Some people can’t keep their jaw closed while wearing the mask. A chin strap can help hold up your jaw to keep the air in (see the picture below).
  • You don’t like the pressure. You may find that breathing out against the air pressure keeps you from sleeping deeply. Your doctor may ask you to use a bi-level machine that lowers the air pressure when you breathe out. The same mask may be used with CPAP and bi-level machines.
  • You take the mask off during your sleep or don’t wear it every night. Most people can’t wear the mask all night long, every night, right from the start. Keep trying, even if you can only use the mask for an hour a night at first. Once you solve your comfort problems, you should be able to increase the time you wear the mask.
  • You just can’t get used to the mask. Some people find that wearing a dental device that pushes their tongue forward helps. You may want to talk with your doctor about whether throat or jaw surgery could help.

Sleep Changes in Older Adults

How much sleep do older adults need?

Most adults need 7 or 8 hours of sleep each night to feel fully alert during the day. This is usually also true for people age 65 or older. But as we get older, we might have more trouble sleeping. Many things can get in the way of sleeping well or sleeping long enough to be fully rested.
 

What sleep changes are common in older adults?

Older adults might get sleepy earlier in the evening. Older adults may have trouble falling asleep when they go to bed at night or they might not stay asleep all night (called insomnia). They might wake up very early in the morning and not be able to go back to sleep.
 

What causes sleep problems?

A number of things can cause sleep problems. By the time an adult is over 65 years old, his or her sleep-wake cycle may not seem to work as well as it did when he or she was younger. As we age, our body makes less of the chemicals and hormones that help us sleep well (growth hormone and melatonin). Some lifestyle habits (such as smoking and drinking alcohol or caffeinated drinks) can cause sleep problems. Sleep problems may be caused by illness, by pain that keeps a person from sleeping or by medicines that keep a person awake. However, people of all ages can have a sleep disorder such as sleep apnea. Restless legs syndrome or periodic limb movement disorder are also conditions that can cause problems with sleep.
 

What is sleep apnea?

Sleep apnea is a disorder in which a person stops breathing repeatedly while asleep. People who have sleep apnea usually snore very loudly. They stop breathing for 10 to 30 seconds during sleep and then start breathing again with a gasp. This can happen hundreds of times in a night. Every time this happens it causes the person to wake up a little bit, which disrupts sleeping patterns and makes it hard for the person to get a good night’s rest. It can also cause high blood pressure and increase the risk of heart attack.

If you have sleep apnea and are overweight, it might help to lose weight. If you smoke, you should quit. It will also help to sleep on your side, stop drinking alcohol or using sleep medicines. Many people who have sleep apnea need to wear a nasal mask during the night to keep their airways open. The mask treatment is called “continuous positive airway pressure,” or CPAP. It helps you breathe normally during sleep. Surgery is an option for people who have severe cases of sleep apnea.

What is restless legs syndrome (RLS)?

RLS is a condition in which your legs feel very uncomfortable when you are sitting or lying down. RLS can make it hard for you to sleep.
 

What is periodic limb movement disorder (PLMD)?

PLMD is a condition in which a person kicks one or both legs many times during sleep. Often the person doesn’t even know about the kicking unless a bed partner talks about it. It prevents good sleep and causes daytime sleepiness. Some people who have restless legs syndrome also have periodic limb movements during sleep. Medicine may help both of these problems.
 

What can I do to sleep better?

  • Go to bed and get up at the same time every day, even on the weekends.
  • Do not take naps longer than about 20 minutes.
  • Don’t read, snack or watch TV in bed. Use your bedroom for sleep and other rooms for other activities
  • Avoid caffeine about 8 hours before bedtime.
  • Avoid nicotine and alcohol in the evening. Alcohol might help you fall asleep initially, but it will probably make you wake up in the middle of the night.
  • Don’t lie in bed for a long time trying to go to sleep. After 30 minutes of trying to sleep, get up and do something quiet for a while in a different room, such as reading or listening to quiet music. Then try again to fall asleep in bed.
  • Ask your doctor if any of your medicines could be keeping you awake at night. Medicines that can disrupt sleep include antidepressants, beta-blockers and cardiovascular drugs.
  • Ask your doctor for help if pain or other health problems keep you awake.
  • Try to exercise a little every day. Exercise helps many older adults sleep better.

Constipation

What is constipation?

Constipation is a common digestive problem. It may be difficult for you to have a bowel movement, or your bowel movements may be infrequent. Your stools may be very hard, making them so difficult to pass that you have to strain. Or you may feel like you still need to have a bowel movement even after you’ve had one.
 

How often should I have a bowel movement?

Not everyone has bowel movements once a day. It’s not true that you must have a daily bowel movement to be considered “regular.” A normal range is anywhere between 3 times a day to 3 times a week. You may be getting constipated if you start having bowel movements much less often than you usually do.
 

Tips on preventing constipation

  • Don’t resist or ignore the urge to have a bowel movement.
  • Set aside time to have a bowel movement. A good time may be after breakfast or any other meal.
  • Eat more fiber.
  • Drink plenty of fluids (8 glasses a day is a good goal). Fluids can include water, juices, soup, tea and other drinks.
  • Don’t take laxatives too often. Overuse of laxatives may damage your bowels and may actually make constipation worse.
  • Exercise more often.
  • Limit foods that are high in fat and sugar (such as sweets, cheese and processed foods). These foods may cause constipation.

What causes constipation?

As the food you eat passes through your digestive tract, your body takes nutrients and water from the food. This process creates a stool, which is moved through your intestines with muscle contractions (squeezing motions).

A number of things can affect this process. These include not drinking enough fluids, not being active enough, not eating enough fiber, taking certain medicines, not going to the bathroom when you have the urge to have a bowel movement and regularly using laxatives. Constipation is also common in pregnant women. Any of these things can cause the stools to move more slowly through your intestines, leading to constipation.

How is constipation treated?

Eating enough fiber and drinking enough fluids are key to treating constipation. They help your stools move through your intestines by increasing the bulk of your stools and making your stools softer. Increasing how often you exercise will also help.

Talk to your family doctor if:

  • Constipation is new and unusual for you
  • You have constipation for 3 weeks or more despite at-home treatment (such as diet changes)
  • You have abdominal pain
  • You notice any blood in your stools
  • You lose weight without reason

What should I eat?

Eat plenty of fiber. At least 2 cups of fruits and 2 1/2 cups of vegetables per day is recommended. It is suggested that men age 50 and younger consume at least 38 grams of fiber per day, while women age 50 and younger should consume at least 25 grams per day. Add extra fiber to your diet by eating cereals that contain bran or by adding bran as a topping on your fruit or cereal.

If you are adding fiber to your diet, start slowly and gradually increase the amount. This will help reduce gas and bloating. Make sure to drink plenty of water, also.

Foods rich in fiber

  • Unprocessed wheat bran
  • Unrefined breakfast cereals
  • Whole-grain bread and brown rice
  • Fresh fruits
  • Dried fruits (such as prunes, apricots and figs)
  • Vegetables
  • Beans (such as navy, kidney and pinto beans)

Should I use laxatives?

Laxatives should usually be avoided. They aren’t meant for long-term use. An exception to this is bulk-forming laxatives.

Bulk-forming laxatives work naturally to add bulk and water to your stools so that they can pass more easily through your intestines. Bulk-forming laxatives can be used every day. They include oat bran, psyllium (one brand: Metamucil), polycarbophil (one brand: FiberCon) and methylcellulose (one brand: Citrucel).

How are bulk-forming laxatives used?

You must use bulk-forming laxatives daily for them to work. Follow the directions on the label. Start slowly and drink plenty of fluids. Gradually increase how much you use every 3 to 5 days (as your body gets used to it) until your stools are softer and easier to pass.

You can help bulk-forming laxatives taste better by mixing them with fruit juice.

Do bulk-forming laxatives have side effects?

You may notice some bloating, gas or cramping at first, especially if you start taking too much or increase the amount you’re using too quickly. These symptoms should go away in a few weeks or less.

Is mineral oil a good laxative?

Mineral oil should generally be used only when your doctor recommends it, such as if you’ve just had surgery and shouldn’t strain to have a bowel movement. Mineral oil shouldn’t be used regularly. If it is used regularly, it can cause deficiencies of vitamins A, D, E and K.

Should I try enemas?

Enemas aren’t usually necessary to relieve constipation. It’s better to let your body work naturally.

What if I've been using enemas or laxatives for a long time?

You may have to retrain your body to go without laxatives or enemas if you’ve been using them for a long period of time. This means eating plenty of fiber, possibly using a bulk-forming laxative, drinking plenty of water, exercising and learning to give yourself time to have a bowel movement.

If you’ve used laxatives and enemas for a long time, your family doctor may suggest that you gradually reduce the use of them to give your body a chance to return to normal. Be patient because it may take many months for your bowels to get back to normal if you’ve been using laxatives or enemas regularly. Talk with your family doctor about any concerns you have.

Oral Diabetes Medicines

Why did my doctor prescribe oral diabetes medicine for me?

If you have type 2 diabetes, your body’s tissues do not get enough insulin. This results in high blood sugar levels. Some people who have type 2 diabetes don’t make enough insulin. Other people make enough insulin but their bodies are not able to use it properly.

Some people who have type 2 diabetes need to take insulin in shots to help control their blood sugar levels. Most take pills by mouth (oral medicine) to help control their diabetes. Some people take insulin and oral medicines.

What are some common oral diabetes medicines?

There are 5 types of oral diabetes medicines. Your doctor will decide which type of medicine is right for you.

Sulfonylureas help your body make more insulin. These are the most common type of oral diabetes medicine. Some examples of sulfonylureas include acetohexamide (brand name: Dymelor), chlorpropamide (brand name: Diabinese), glipizide (brand name: Glucotrol) and glyburide (brand names: DiaBeta, Glynase, Micronase).

Metformin (brand name: Glucophage) helps control blood sugar in a couple of ways. It helps your body use insulin better. It also helps your body make less sugar and reduces the amount of sugar your body absorbs from food. It almost never causes hypoglycemia (low blood sugar).

Meglitinides help your body make more insulin. Examples include nateglinide (brand name: Starlix) and repaglinide (brand name: Prandin). These pills are usually taken with meals.

Thiazolidinediones help your body use insulin better. They also help your body make less sugar. There are 2 thiazolidinediones: pioglitazone (brand name: Actos) and rosiglitazone (brand name: Avandia).

Alpha-glucosidase inhibitors help your body absorb sugar more slowly to keep your blood sugar lower. This type of medicine is taken every time you eat a meal. There are 2 alphaglucosidase inhibitors: acarbose (brand name: Precose) and miglitol (brand name: Glyset).

Sometimes two kinds of medicines are given together. For example, glyburide combined with metformin (brand name: Glucovance), glipizide combined with metformin (brand name: Metaglip) and rosiglitazone combined with metformin (brand name: Avandamet).

Do these medicines have any side effects?

Like most medicines, these drugs can cause side effects. Your doctor may want to see you or want you to have tests (like liver tests) to check for problems. However, the side effects usually are not severe and are not common. Side effects of oral diabetes medicines may include the following:
 
  • Nausea and vomiting
  • Diarrhea
  • Gas and bloating
  • Decreased appetite
  • Headache and/or muscle aches
  • Flu- or cold-like symptoms
Talk to your doctor about any side effects you may be having.

Will a diabetic drug interact with my other medicines?

If you take 2 or more drugs at the same time, how the drug works can change. When this happens, the risk of side effects increases. This is called a “drug-drug interaction.” Vitamins and herbal supplements can affect the way your body processes drugs too.

Drug-drug interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

Certain foods or drinks can also keep your medicine from working the way it should or make side effects worse. This is called a “drug-food interaction.” For example, if you’re taking an oral diabetes medicine, drinking alcohol can increase your risk of low blood sugar.

Ask your doctor whether you need to avoid any foods or drinks while using your oral diabetes medicine. And take medicines exactly as your doctor tells you to.

Know the signs

People who have diabetes need to know the signs of hyperglycemia (high blood sugar ) and hypoglycemia (low blood sugar). Make sure your family members, friends and coworkers know how to help you in an emergency situation.

Signs of low blood sugar:
 
  • Shakiness
  • Drowsiness
  • Cold sweats and pale, cool skin
  • Headache
  • Confusion
  • Fast heartbeat
  • Extreme hunger
  • Diarrhea or gas
Exercising more than usual can sometimes cause low blood sugar. Keep candy, juice or glucose tablets on hand to treat low blood sugar. Call your doctor if your symptoms become severe or bothersome.

Signs of high blood sugar:

  • Increased hunger
  • Increased thirst
  • Increased urination
Eating more than you usually do, forgetting to take your diabetes medicine, or taking another medicine that you don’t usually take can all cause high blood sugar. Call your doctor if any of the above symptoms become severe.

Fecal Incontinence

What is fecal incontinence?

Fecal incontinence is the inability to control of the bowel movements. This leads to stool (feces) leaking from the rectum (the last part of the large intestine) at unexpected times. This problem affects as many as more than 5.5 million Americans. It is more common in women and in the elderly of both sexes.

Many people with fecal incontinence are ashamed to talk about this problem with their doctor. They think that nothing can help them. However, many effective treatments for fecal incontinence are available.

Why does fecal incontinence occur?

Bowel function is controlled by 3 things: anal sphincter pressure, rectal sensation and rectal storage capacity. The anal sphincter is a muscle that contracts to prevent stool from leaving the rectum. This muscle is critical in maintaining continence. This is the rectal storage capacity. Rectal sensation tells a person that stool is in the rectum and that it is time to go to the bathroom. The rectum can stretch and hold stool for some time after a person becomes aware that the stool is there.

A person also must be alert enough to notice the rectal sensation and do something about it. He or she must also be able to move to a toilet. If something is wrong with any of these factors, then fecal incontinence can occur.

What causes fecal incontinence?

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It’s especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery such as surgery for hemorrhoids. It may also occur in people with inflammatory bowel disease or a perirectal abscess.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming loose.

Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations:
  • During childbirth.
  • With severe and prolonged straining for stool.
  • With diseases such as diabetes, spinal cord tumors and multiple sclerosis.
Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.

If I have fecal incontinence, what can be done?

Fortunately, effective treatment for fecal incontinence is available, so it’s important that you talk to your doctor about it. Attempts at self-treatment are usually unsuccessful. Along with a physical exam, your doctor may want to do other tests such as an anorectal manometry, which tests anal pressure, rectal elasticity and rectal sensation. These tests can pinpoint the cause of your incontinence.

The treatment of fecal incontinence varies and depends on the cause of your problem. Your doctor may recommend one or more of the following treatments:
  • Dietary changes: Preventing diarrhea and constipation are usually very helpful in controlling incontinence. Changes in your diet such as adjusting the amount of fiber you eat, drinking more fluids, or changing the amount of food you eat can often prevent diarrhea and constipation.
  • Medicine: Your doctor may prescribe laxatives, anti-diarrhea drugs or stool softeners to treat incontinence. Talk to your doctor before you take any over-the-counter incontinence medicines.
  • Bowel training: Developing a regular bowel movement pattern can be very helpful. This may involve going to bathroom at specific times of the day such as after you eat, or a treatment called anorectal biofeedback. This procedure measures your sphincter contractions while you do special exercises–called Kegel exercises. Biofeedback training can strengthen your sphincter muscles and give you more control over bowel movements.
  • Surgery: Several different surgical procedures can treat fecal incontinence. Often these surgeries repair or replace sphincter muscles.

Urinary Incontinence: Bladder Training

What is urinary incontinence?

Urinary incontinence means that you can’t always control when you urinate. Urinary incontinence is caused by weak pelvic muscles, certain medicines, build-up of stool in the bowels, and problems such as diabetes and congestive heart failure. About 12 million adults in the United States have urinary incontinence. It’s most common in women older than 50 years of age, but it can also happen to younger people.

There are 4 main types of urinary incontinence:
  • Stress incontinence
  • Urge incontinence
  • Overflow incontinence
  • Functional incontinence
Your doctor will help you determine which type of incontinence you have and whether bladder training can help you.

What is bladder training?

Bladder training is a way of learning to manage urinary incontinence. It is generally used for stress incontinence, urge incontinence or a combination of the two (called mixed incontinence). Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Urge incontinence is when the need to urinate comes on so fast that you can’t get to a toilet in time. Some bladder training techniques are explained below.
 

How can bladder training help?

Bladder training can help in the following ways:
  • Lengthen the amount of time between bathroom trips.
  • Increase the amount of urine your bladder can hold.
  • Improve your control over the urge to urinate.

Are there other ways to treat incontinence?

Yes. Medicines or medical devices can treat some types of urinary incontinence. In some cases, surgery may be an option. Treatment depends on what type of urinary incontinence you have and what is causing it.

Where do I start?

Ask your doctor about starting a bladder training program. He or she may ask you to keep a diary to record how much and how often you urinate. This information will help your doctor create a plan that’s right for you.

Three bladder training methods are listed below. Your doctor may recommend 1 or more of these methods to help control your incontinence.
  • Kegel exercises: These are exercises that help strengthen the muscles you use to stop the flow of urine.
  • Delay urination: Some people who have urge incontinence can learn to put off urination when they feel the urge. You start by trying to hold your urine for 5 minutes every time you feel an urge to urinate. When it’s easy to wait 5 minutes, you try to increase the time to 10 minutes until you’re urinating every 3 to 4 hours. When you feel the urge to urinate before your time is up, you can try relaxation techniques. Breathe slowly and deeply. Concentrate on your breathing until the urge goes away. Kegel exercises may also help control urges.
  • Scheduled bathroom trips: Some people control their incontinence by going to the bathroom on a schedule. This means that you go to the bathroom at set times, whether you feel the urge or not. For example, you might start by going to the bathroom every hour. Then gradually you increase the time until you find a schedule that works for you.
Keep in mind that bladder training can take 3 to 12 weeks. During your training program, your doctor may have you keep track of the number of urine leaks you have each day. This will help you and your doctor see if bladder training is helping. Don’t be discouraged if you don’t have immediate results or if you still experience some incontinence.

What else can I do?

You may find it helpful to make some changes in your diet. Alcohol, caffeine, foods high in acid (such as tomato or grapefruit), and spicy foods can irritate your bladder. Talk to your doctor if you think your diet may contribute to your incontinence.

Some people find that limiting how much they drink before bedtime helps reduce nighttime incontinence.

Losing weight if you are overweight can also help reduce incontinence.

Kegel Exercises for your pelvic muscles

How do pelvic muscles get weak?

Pelvic muscles help stop the flow of urine. For women, pregnancy, childbirth and being overweight can weaken the pelvic muscles. For men, prostate surgery can weaken pelvic muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles–exercises can make them stronger. People who leak urine may have better control of these muscles by doing pelvic muscle exercises called Kegel exercises.

This handout focuses on Kegel exercises for women because it is much more common for women to leak urine than for men. If you are a man who leaks urine, talk to your doctor about whether Kegel exercises can help you.
 

Which muscles control my bladder?

At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle (see picture below).
 
These are the same muscles that you would use to try to stop the flow of urine. They are the muscles you will exercise and strengthen.

How do I exercise my pelvic muscles?

You can exercise almost anywhere and any time–while driving in a car, at your desk or watching TV. To exercise these muscles, just pull in or “squeeze” your pelvic muscles (as if you are trying to stop urine flow). Hold this squeeze for about 10 seconds, then rest for 10 seconds. Do sets of 10 to 20 contractions per day.

Be patient and continue to exercise. It takes time to strengthen the pelvic muscles, just like it takes time to improve the muscles in your arms, legs or abdomen. You may not notice any change in bladder control until after 6 to 12 weeks of daily exercises. Still, most women notice an improvement after just a few weeks.

A few points to remember

  • Weak pelvic muscles often lead to urine leakage.
  • Daily exercises can strengthen pelvic muscles.
  • These exercises often improve bladder control.
  • Ask your doctor or nurse if you are squeezing the right muscles.
  • Tighten your pelvic muscle before sneezing, lifting a heavy object or jumping. This can prevent pelvic muscle damage and urine leakage.

Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is the loss of bladder control. This means that you can’t always control when you urinate. Urinary incontinence can range from leaking a small amount of urine (such as when coughing or laughing) to having very strong urges to urinate that are difficult to control. This can be embarrassing, but it can be treated.

Millions of adults in the United States have urinary incontinence. It’s most common in people over 50 years old, especially women. But it can also affect younger people, especially women who have just given birth.

Be sure to talk to your doctor if you have this problem. If you hide your incontinence, you risk getting rashes, sores, skin infections and urinary tract infections. Also, you may find yourself avoiding friends and family because of fear and embarrassment.
 

What causes incontinence?

Urinary incontinence can be caused by many different medical problems, including weak pelvic muscles or diabetes. See the box below for a list of common causes.
 

Is urinary incontinence just part of growing older?

No. But changes with age can reduce how much urine your bladder can hold. Aging can make your stream of urine weaker and can cause you to feel the urge to urinate more often. This doesn’t mean you’ll have urinary incontinence just because you’re aging. With treatment, it can be controlled or cured.
 

How can it be treated?

Treatment depends on what’s causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence through strengthening the pelvic muscles. Medicine and surgery are other options.
 

What are Kegel exercises?

Stress incontinence can be treated with special exercises, called Kegel exercises (see the box below). These exercises help strengthen the muscles that control the bladder. They can be done anywhere, any time. Although designed for women, the Kegel exercises can also help men. It may take 3 to 6 months to see an improvement.
 

Kegel exercises

  • To locate the right muscles, try stopping or slowing your urine flow without using your stomach, leg or buttock muscles. When you’re able to slow or stop the stream of urine, you’ve located the right muscles.
  • Squeeze your muscles. Hold for a count of 10. Relax for a count of 10.
  • Repeat this 10 to 20 times, 3 times a day.
  • You may need to start slower, perhaps squeezing and relaxing your muscles for 4 seconds each and doing this 10 times, 2 times a day. Work your way up from there.

Causes of urinary incontinence

  • For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
  • For men, enlarged prostate gland or prostate surgery
  • Weakened and stretched pelvic muscles after childbirth
  • Certain medicines
  • Build-up of stool in the bowels
  • Overweight and obesity, which increases pressure on the bladder and muscles that control the bladder
  • Urinary tract infections
  • Vascular disease
  • Diseases such as diabetes, Alzheimer’s disease and multiple sclerosis

Will medicine or surgery help?

Medicine helps some types of urinary incontinence. For example, estrogen cream to put in the vagina can be helpful for some women who have mild stress incontinence. Several prescription medicines are available to treat urge incontinence. For men, prescription medicine is available to shrink the prostate and improve flow of urine through the prostate. Talk to your doctor about possible medicine options for your type of incontinence.

Surgery can sometimes be helpful, especially in stress incontinence in women and in overflow incontinence in men due to an enlarged prostate. It is usually only performed if other treatments haven’t worked or if the incontinence is severe.

Are there different types of incontinence?

Yes. There are 5 types of urinary incontinence. A brief explanation of each follows.

Stress incontinence
Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women.

Urge incontinence
This occurs when the need to urinate comes on very suddenly, often before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of a urinary tract infection or an overactive bladder.

Overflow incontinence
This type of incontinence is the uncontrollable leakage of small amounts of urine. It’s caused by an overfilled bladder. You may feel like you can’t empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause the problem.

Functional incontinence
This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.

Mixed incontinence
This type involves more than one of the types of incontinence listed above.

What is bladder training?

Some people who have urge incontinence can learn to lengthen the time between urges to go to the bathroom. You start by urinating at set intervals, such as every 30 minutes to 2 hours (whether you feel the need to go or not). Then gradually lengthen the time between when you urinate (fore example, by 30 minutes) until you’re urinating every 3 to 4 hours.

You can practice relaxation techniques when you feel the urge to urinate before it is time to go to the bathroom. Breathe slowly and deeply. Think about your breathing until the urge goes away. You can also do Kegel exercises if they help control your urge.

After the urge passes, wait 5 minutes and then go to the bathroom even if you don’t feel you need to go. If you don’t go, you might not be able to control your next urge. When it’s easy to wait 5 minutes after an urge, begin waiting 10 minutes. Bladder training may take 3 to 12 weeks.

Menopause: What to Expect when your body is changing

What is menopause?

Menopause is a normal part of a woman’s life. It is when the menstrual periods permanently end. This happens because as a woman ages, her ovaries make less of the female hormones estrogen and progesterone. These are the hormones that regulate your menstrual cycle.
 

Does menopause have emotional symptoms?

Many women experience emotional symptoms during menopause. These symptoms may include sadness, anxiety and mood swings. For some women, symptoms can be severe. If you find that you’re having emotional problems, talk to your family doctor.

Talk to your doctor if you have:

  • A change in your monthly cycle
  • Heavy bleeding
  • Bleeding that lasts longer than usual
  • Bleeding more often than every 3 weeks
  • Bleeding after sexual intercourse
  • Any blood spotting between periods

Are other treatments available?

Yes. Medicines such as estrogen cream, low-dose antidepressants, soy products and certain herbal supplements may help ease some menopausal symptoms. Discuss these options with your doctor.

When does menopause occur?

The average age for women to have their last period is about 51. But it’s normal for menopause to occur any time from age 40 to 59. A woman often goes through menopause at about the same age as her mother.

Women who have both ovaries removed will go through “surgical menopause” at the time of their surgery. If the uterus is taken out but the ovaries are not, a woman will stop having periods, but she will not go through surgical menopause.

If you stop having periods early (before age 40) your doctor can do a blood test to see if you’re actually going through menopause or if there is another cause for your missed periods.

Menopause is a gradual process that can take several years. You’re not really through menopause until you haven’t had a period for 12 months. (During this time, keep using birth control if you don’t want to become pregnant.)

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is a treatment for menopause that involves taking synthetic hormones (which are made in a laboratory rather than by the body). HRT can be estrogen taken alone or estrogen combined with another hormone, progestin. Some women have found that HRT can relieve symptoms such as hot flashes, vaginal dryness and some urinary problems. However, HRT is not for everyone. New information from recent studies suggests that for many women, the risks of using HRT may outweigh the benefits. Talk to your doctor about the risks and benefits of HRT.
 

What are the common signs and symptoms of menopause?

Help for hot flashes
  • Turn your thermostat down. Sleep in a cool room.
  • Dress in layers, so you can remove clothing when you get too warm.
  • Wear cotton and other natural fabrics that “breathe” so you don’t get overheated. Use cotton sheets on your bed.
  • Drink cool water or other beverages when a hot flash starts.
  • Get plenty of exercise.
  • Find out what triggers your hot flashes and avoid them. Spicy foods, alcohol, tight clothing and hot humid weather are some common triggers.
Some women just stop having periods. Most women experience some symptoms, such as the following:

A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.

Hot flashes. Hot flashes are the most common symptom of menopause.

When you have a hot flash, you’ll feel warm from your chest to your head, often in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.

Vaginal dryness. During and after menopause, the skin of your vagina and vulva (the area around your vagina) becomes thinner. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex.

You can use an over-the-counter water-based sexual lubricant (such as K-Y Jelly) or moisturizers for the vaginal area (such as Vagisil) to make sex less painful. You can also talk to your doctor about the benefits and risks of using prescription estrogen cream for vaginal changes.

Urinary tract problems. You’re more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom often, feel an urgent need to urinate, feel a burning sensation when urinating or are not able to urinate.

Headaches, night sweats, trouble sleeping and tiredness are other symptoms. Trouble sleeping and feeling tired may be caused by hot flashes and night sweats that keep you from getting a good night’s rest.

Weight gain. Many women gain weight during menopause. A healthy diet and exercising most, if not all, days of the week will help keep you fit.
 
 

Osteoporosis in Women:
Keeping your Bones Healthy and Stong

What is osteoporosis?

In osteoporosis, the inside of the bones becomes porous from a loss of calcium (see the picture below). This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break.

Osteoporosis is much more common in women than in men. This is because women have less bone mass than men, tend to live longer and take in less calcium, and need the female hormone estrogen to keep their bones strong. If men live long enough, they are also at risk of getting osteoporosis later in life.

Once total bone mass has peaked—around age 35—all adults start to lose it. In women, the rate of bone loss speeds up after menopause, when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may also occur if both ovaries are removed by surgery.
 

What are the signs of osteoporosis?

You may not know you have osteoporosis until you have serious signs. Signs include broken bones, low back pain or a hunched back. You may also get shorter over time because osteoporosis can cause your vertebrae (the bones in your spine) to collapse. These problems tend to occur after a lot of bone calcium has already been lost.
 

Risk factors for osteoporosis

  • Menopause before age 48
  • Surgery to remove ovaries before menopause
  • Not getting enough calcium
  • Not getting enough exercise
  • Smoking
  • Osteoporosis in your family
  • Alcohol abuse
  • Thin body and small bone frame
  • Fair skin (caucasian or Asian race)
  • Hyperthyroidism
  • Long-term use of oral steroids
See the box to the right for a list of things that put you at risk for osteoporosis. The more of these that apply to you, the higher your risk is. Talk to your family doctor about your risk factors.

Will I need a bone density test?

Check with your doctor. For many women, osteoporosis (or the risk of it) can be diagnosed without testing. When testing is appropriate, doctors use equipment that takes a “picture” of the bones to see if they are becoming porous.
 

What is calcitonin?

Calcitonin (some brand names: Calcimar, Miacalcin) is a hormone that helps prevent further bone loss and reduces the pain that some people have with osteoporosis.

Calcitonin can be taken as a shot or as a nasal spray. Its most common side effect is nausea

What is ibandronate sodium?

Ibandronate sodium (brand name: Boniva) is a new drug that is taken once a month. It is not a hormone, but it slows bone loss and increases bone density. Some of the possible side effects include upset stomach, heartburn, nausea and diarrhea.
 

What are alendronate and risedronate?

Alendronate (brand name: Fosamax) and risedronate (brand name: Actonel) are not hormones, but are used to help prevent and treat osteoporosis. These drugs help reduce the risk of fractures by decreasing the rate of bone loss. Their most common side effect is an upset stomach.
 

What is raloxifene?

Raloxifene (brand name: Evista) is a drug used to prevent and treat osteoporosis by increasing bone density. It is not a hormone, but it mimics some of the effects of estrogen. Side effects may include hot flashes and a risk of blood clots.
 

What is teriparatide?

Teriparatide (brand name: Forteo) is a new injectable synthetic hormone used once a day for the treatment of osteoporosis. It causes new bone growth. Common side effects may include nausea, dizziness and leg cramps.
 

How much calcium do I need?

Before menopause, you need about 1,000 mg of calcium per day. After menopause, you need 1,000 mg of calcium per day if you’re taking estrogen and 1,500 mg of calcium per day if you’re not taking estrogen.

It’s usually best to try to get calcium from food. Nonfat and low-fat dairy products are good sources of calcium. Other sources of calcium include dried beans, sardines and broccoli.

About 300 mg of calcium are in each of the following: 1 cup of milk or yogurt, 2 cups of broccoli, or 6 to 7 sardines.

If you don’t get enough calcium from the food you eat, your doctor may suggest taking a calcium pill. Take it at meal time or with a sip of milk. Vitamin D and lactose (the natural sugar in milk) help your body absorb the calcium.

Deep Vein Thrombosis

What is deep vein thrombosis?

Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in your leg veins. While DVT is a fairly common condition, it is also a dangerous one. If the blood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal.

How can I prevent DVT?

  • Frequently exercise your lower leg muscles if you’ll be inactive for a long period of time.
  • Get out of bed and move around as soon as you can after having surgery or being ill.
  • After some types of surgery, take medicine to prevent blood clots as directed by your doctor.

What are the symptoms of DVT?

Some people have no symptoms at all. Most have some swelling in one or both legs. Often there is pain or tenderness in one leg (may happen only when you stand or walk). You may also notice warmth, or red or discolored skin in the affected leg. If you have any of these symptoms, call your doctor right away.

If your doctor thinks you might have DVT, he or she will do one or more tests. These may include an ultrasound (uses sound waves to check the blood flow in your veins) or venography (a doctor injects dye into your vein, then takes an x-ray to look for blood clots).

What medicines are used to treat DVT?

The following are the main goals in treating DVT:
  • Stopping the clot from getting bigger.
  • Preventing the clot from breaking off and traveling to your lungs.
  • Preventing any future blood clots.
Several medicines are used to treat or prevent DVT. The most common are anticoagulants (also called blood thinners) such as warfarin (brand name: Coumadin) or heparin. Anticoagulants thin your blood so that clots won’t form. Warfarin is taken as a pill, and heparin is given intravenously (in your veins). If you can’t take heparin, your doctor may prescribe another kind of anticoagulant called a thrombin inhibitor.

What are the side effects of anticoagulants?

Anticoagulants can cause you to bleed more easily. For example, you might notice that your blood takes longer to clot when you cut yourself. You might also bruise more easily. If you have any unusual or heavy bleeding, call your doctor right away.

Warfarin can cause birth defects. Women who are pregnant shouldn’t take warfarin.

Some other medicines can affect how well an anticoagulant works. If you’re taking an anticoagulant, ask your doctor before you take any new medicine, including over-the-counter medicines or vitamins. Certain foods rich in vitamin K, such as dark green vegetables, can also affect how well an anticoagulant works.

What other treatments are used for DVT?

If you can’t take medicine to thin your blood, or if a blood thinner doesn’t work, your doctor may recommend that you have a filter put into your vena cava (the main vein going back to your heart from your lower body). This filter can catch a clot as it moves through your bloodstream and prevent it from reaching your lungs. This treatment is used mostly for people who have had several blood clots travel to their lungs.

Elevation of the affected leg and compression can help reduce swelling and pain from DVT. Your doctor can prescribe graduated compression stockings to reduce swelling in your leg after a blood clot has developed. These stockings are worn from the arch of your foot to just above or below your knee. They cause a gentle compression (pressure) of your leg.

Am I at risk for DVT?

You are at higher risk for DVT if you:
  • are older than 60 years of age;
  • are inactive for a long period of time, such as when you are flying in an airplane, taking a long car trip or recovering in bed after surgery;
  • have inherited a condition that causes increased blood clotting;
  • have an injury or surgery that reduces blood flow to a body part;
  • are pregnant or have recently given birth;
  • are overweight;
  • have varicose veins;
  • have cancer, even if you are being treated for it;
  • are taking birth control pills or hormone therapy, including for postmenopausal symptoms; or
  • have a central venous catheter.
Your risk for DVT increases if you have several risk factors at the same time.

Restless Legs Syndrome

What is restless legs syndrome (RLS)?

Restless legs syndrome (also called RLS) is a condition in which your legs feel very uncomfortable when you are sitting or lying down. It affects both men and women and can occur at any age, including during childhood, but often worsens with age and becomes a problem for older adults. RLS can make sleeping and traveling difficult and uncomfortable. Some cases of RLS are related to other conditions, such as pregnancy, iron-deficiency anemia or kidney failure. Other cases of RLS have no known cause. RLS may be hereditary, which means it can run in your family.

What does it feel like to have RLS?

People who have RLS say it’s difficult to describe their symptoms. If you have RLS, you may have a “creepy-crawly” feeling in your legs that makes you want to move around. You may experience achy, tingly or burning sensations in your legs, which can make it difficult to sleep or sit for long periods of time. Moving your legs makes the feeling go away for a few minutes, but it comes back after you sit or lie still again. Your legs may also twitch when you try and sleep (also called periodic limb movements of sleep or PLMS).
 

How does my doctor know I have RLS?

Tell your doctor about the restless sensations. He or she will ask you questions about your symptoms, such as when they start and whether you’re able to do anything to make them go away. He or she may also ask if any other people in your family have similar symptoms.

Tell your doctor about any medications (including over-the-counter medication) that you’re taking. Certain medications can make RLS symptoms worse. Your doctor can recommend another medicine if this seems to be happening to you.

What else can I do?

Keep your doctor posted on how you’re feeling. He or she can suggest different relaxation techniques and can change your medicine if it’s not helping. You may want to join a support group to talk to other people who are suffering from RLS. Also, because RLS tends to run in families, you may want to talk to your relatives about your RLS and see if they have similar symptoms.

Lifestyle changes to treat RLS

  • For mild symptoms, use an over-the-counter pain reliever to reduce twitching and restless sensations.
  • Cut back on alcohol, caffeine and tobacco.
  • Try taking a hot bath and massaging your legs before bedtime to help you relax.
  • Relaxation techniques, such as meditation and yoga, can help you relax before bed.
  • Apply warm or cool packs, which can help relieve sensations in your legs.
  • Try to distract your mind by reading, doing a crossword puzzle or playing a video game while you wait for sleep to come.
  • Moderate exercise may help, but don’t overdo it–exercising vigorously or late in the day may make symptoms worse.
  • Try to go to bed at the same time every night and arise at the same time every morning. Also try to get a sufficient amount of sleep each night.

What is the treatment for RLS?

Treatment for RLS includes medications and lifestyle changes. See the box below for a list of things that you can do at home to help relieve your symptoms.

Medications used to treat Parkinson’s disease can help reduce tremors and twitching in the legs. If your iron levels are low, your doctor may prescribe an iron supplement. Sleep aids, muscle relaxants (called benzodiazepines) and pain medications (called opioids) may also relieve symptoms. In some cases, an anticonvulsant medicine (usually used to stop seizures) can be helpful. For many cases of RLS, a combination of medications is usually needed to best treat the condition. Your doctor may prescribe several trials of medication before finding one that works best for your case of RLS.

Cholesterol-lowering Medicines

Why did my doctor prescribe cholesterol-lowering medicine for me?

Lowering your “bad” cholesterol (also called LDL, or low-density lipoprotein) can reduce your risk of having a heart attack or stroke. A number of lifestyle changes can help you improve your cholesterol level (see the box below). However, if these lifestyle changes don’t help after about 6 months to 1 year, your doctor may suggest medicine to lower your cholesterol.

Even if you take cholesterol-lowering medicine, it’s important to keep up with your lifestyle changes. Eating a healthy diet and being physically active can make your medicine more effective. Your doctor can give you tips on how to make healthy food choices and include physical activity in your daily routine.

Lifestyle changes

  • Avoid smoking cigarettes or using any other tobacco product.
  • Get regular physical activity.
  • Eat a healthy low-fat diet that includes lots of fruits and vegetables.
  • Limit how much alcohol you drink.

What is a drug interaction?

If you take 2 or more medicines at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a “drug-drug interaction.” Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a “drug-food interaction.”

Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine, or use a vitamin or herbal supplement.

It’s important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using your cholesterol-lowering medicine.

What are some common cholesterol-lowering medicines?

Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.

Statins (also called HMG-CoA reductase inhibitors) slow down your body’s production of cholesterol. These drugs also remove cholesterol buildup from your arteries (blood vessels). Examples of statins include atorvastatin (brand name: Lipitor), fluvastatin (brand name: Lescol), lovastatin (brand names: Altocor, Mevacor), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor) and simvastatin (brand name: Zocor).

Resins (also called bile acid sequestrants) help lower your LDL cholesterol level. Some examples of bile acid sequestrants include cholestyramine (brand names: Prevalite, Questran), colesevelam (brand name: Welchol) and colestipol (brand name: Colestid).

Fibrates (also called fibric acid derivatives) help lower your cholesterol by reducing the amount of triglycerides (fats) in your body and by increasing your level of “good” cholesterol (also called HDL, or high-density lipoprotein). Some examples of fibrates include fenofibrate (brand names: Antara, Lofibra, Tricor) and gemfibrozil (brand name: Lopid).

Niacin (also called nicotinic acid) is a B vitamin. When given in large doses, it can lower your levels of triglycerides and LDL cholesterol, and increase your HDL cholesterol level. Even though you can buy niacin without a prescription, you should not take it to lower your cholesterol unless your doctor prescribes it for you. It can cause serious side effects.

Cholesterol absorption inhibitors help lower your cholesterol by reducing the amount that is absorbed by your intestines. Ezetimibe (brand name: Zetia) is a cholesterol absorption inhibitor. This type of medicine is often given in combination with a statin. The combination of ezetimibe and simvastatin (brand name: Vytorin) is an example.

Do cholesterol-lowering medicines have any side effects?
Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.

Common side effects of cholesterol-lowering drugs include the following:

 
  • Diarrhea or constipation
  • Abdominal pain, cramps, bloating or gas
  • Nausea and/or vomiting
  • Headache
  • Drowsiness or dizziness
  • Muscle aches or weakness
  • Flushing (skin turning red and warm)
  • Sleep problems
 
Tell your doctor as soon as possible if your side effects become severe.

Prescription Nonsteroidal Anti-Inflammatory Medicines

How do prescription nonsteroidal anti-inflammatory drugs work?

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body from working. COX enzymes speed up your body’s production of hormone-like substances called prostaglandins. Prostaglandins cause the feeling of pain by irritating your nerve endings. They are also part of the system that helps your body control its temperature.

By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers and prevent blood from clotting.

What are some common prescription NSAIDs?

There are 2 classes of prescription NSAIDs.

Traditional NSAIDs include the following:

  • Diclofenac (brand names: Cataflam, Voltaren)
  • Etodolac (brand name: Lodine)
  • Fenoprofen (brand name: Nalfon)
  • Flurbiprofen (brand name: Ansaid)
  • Ibuprofen (2 brand name: Advil, Motrin)
  • Indomethacin (brand name: Indocin)
  • Ketoprofen (brand names: Orudis, Oruvail)
  • Meclofenamate
  • Meloxicam (brand name: Mobic)
  • Nabumetone (brand name: Relafen)
  • Naproxen (brand names: Anaprox, Naprelan, Naprosyn)
  • Oxaprozin (brand name: Daypro)
  • Piroxicam (brand name: Feldene)
  • Sulindac (brand name: Clinoril)
  • Tolmetin (brand name: Tolectin)
COX-2 inhibitors include celecoxib (brand name: Celebrex).

If you need to take a prescription NSAID, your doctor will help you find one that is right for you.

What's the main difference between traditional NSAIDs and COX-2 inhibitors?

You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn’t play a role in protecting your stomach.

Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation is reduced, but the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers and bleeding in your stomach and intestines.

COX-2 inhibitors only stop COX-2 enzymes from working. Since the COX-2 enzyme doesn’t help to protect your stomach, COX-2 inhibitors may be less likely to irritate your stomach or intestines.

Do prescription NSAIDs have any side effects?

Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.

Common side effects of prescription NSAIDs may include the following:
 
  • Dizziness or headache
  • Nausea, excess gas, diarrhea or constipation
  • Extreme tiredness or weakness
  • Dry mouth
Serious side effects of prescription NSAIDs may include the following:

  • Allergic reaction, such as difficulty breathing, hives, swelling of the lips, tongue or face
  • Muscle cramps, numbness or tingling
  • Rapid weight gain
  • Black, bloody or tarry stools
  • Blood in urine or vomit
  • Decreased hearing or ringing in the ears
  • Yellowing of skin and eyes (jaundice)
  • Abdominal cramping, heartburn or indigestion
In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for the following side effects:

  • Swelling or water retention
  • Skin rash or itching
  • “Flu-like” symptoms
  • Unusual bruising or bleeding
  • Difficulty sleeping (insomnia)
Call your doctor as soon as possible if your side effects become severe.

Is it safe to take NSAIDs for a long period of time?

People who take NSAIDs increase their risk for severe bleeding in their stomachs. They may also be at risk for heart attacks and strokes. These risks gets worse if they take higher doses and/or if they take these medicines for a long period of time. Patients who need to take pain medicine for longer than a week should discuss this risk and explore other pain treatment options with their family doctor.
 

What is a drug interaction?

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a “drug-drug interaction.” Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a “drug-food interaction.” For example, if you’re taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding.

Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

It’s important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.

Depression After a Heart Attack

What does depression have to do with my heart attack?

As many as 1 out of every 3 people who have a heart attack report feeling depressed. Women, people who have been depressed before, and people who feel alone and without social or emotional support are at a higher risk for feeling depressed after a heart attack.

Being depressed can make it harder for you to recover. However, depression can be treated.

What is depression?

Depression is a medical illness, like diabetes or high blood pressure. The symptoms of depression can include the following:

 
  • Feeling sad or crying often (depressed mood)
  • Losing interest in daily activities that used to be fun
  • Changes in appetite and weight
  • Sleeping too much or having trouble sleeping
  • Feeling agitated, cranky or sluggish
  • Loss of energy
  • Feeling very guilty or worthless
  • Problems concentrating or making decisions
  • Thoughts of death or suicide

How will I know if I am depressed?

People who are depressed have most or all of the above symptoms nearly every day, all day, for 2 or more weeks. One of the symptoms must be depressed mood or loss of interest in daily activities.

If you have some or all of the above symptoms, see your family doctor. Your doctor will ask you questions about your symptoms, your health and your family’s history of health problems.

How is depression treated?

Depression can be treated with medicine, counseling or both.

Depression can be caused by a chemical imbalance in the brain. Medicines called antidepressants can correct this imbalance. If your doctor prescribes an antidepressant medicine for you, follow his or her advice on how to take it. These medicines can take a few weeks to start working, so be patient. Also, be sure to talk to your doctor before you stop taking any medicine or if you have any unusual symptoms.

How you think about yourself and your life can also play a part in depression. Counseling can help you identify and stop negative thoughts and replace them with more logical or positive thinking. Many people who are depressed, and their families, benefit from counseling.

What else can I do to help myself feel better?

Many times people feel depressed because they are inactive and aren’t involved in social and recreational activities. You may find that participating in a hobby or recreational activity improves your mood. Interacting more with other people or beginning an exercise program can also help you feel better. Many people who have had a heart attack benefit physically and mentally from a cardiac rehabilitation program. Talk to your doctor about what kinds of activities and exercise programs are right for you.

Does treatment for depression usually work?

Yes. Treatment helps between 80% and 90% of people with depression.
 

Hospice Care

What is hospice care, and what are its purposes?

Hospice is the term for a special program of care for terminally ill (dying) patients and their families. Rather than trying to cure an illness, hospice efforts aim to make the patient comfortable, ease pain and other troublesome symptoms and support the family through a sad and difficult time.

A hospice care program tries to provide the best quality of life for dying patients by providing a holistic approach. That means giving spiritual, mental, emotional and physical comfort to the patients, their families and their other caregivers.

What is a hospice team?

A hospice team is a group of people who understand the special goals of hospice care. The team includes doctors, nurses, social workers, spiritual counselors, home health aides, bereavement counselors and volunteers. The hospice team helps patients live out their final days with dignity and with as much physical comfort as possible.

Is hospice care available to nursing home residents?

Yes. The services of hospice care programs are provided wherever patients are spending their final days. This includes their own home, a family member’s home, a hospital, a nursing home or a hospice facility.

The members of the hospice team try to help nursing home patients be as free of pain as possible. They also try to help them be at peace with themselves and their illness. At the same time, the hospice team provides support, education and counseling to family members, nursing home staff and other nursing home residents who know the patient.

What specific services does a hospice program provide?

Hospice care programs can provide the following services:

  • Around-the-clock nursing care.
  • Training of family members in patient care, as appropriate.
  • Spiritual and emotional support for both the patient and the family.
  • Help with practical matters associated with terminal illness.
  • Speech, occupational and physical therapies (when these services are considered useful by the hospice team).
  • Coordination of services and care with the patient’s family doctor.
  • Expert management of physical symptoms.
  • Bereavement and support groups for families.

What is bereavement support?

Bereavement support is help in coping with the loss of a loved one. Grieving is a normal psychological process that nursing home staff members, family members and friends go through when a person they love or take care of passes away.

Normal grief has no timetable or calendar. People experience grief in many different ways. Many people feel anger, loneliness, guilt, confusion and fear after a loved one dies. It helps to be able to talk about these feelings and about the person who has passed away.

Hospice is committed to helping people who are grieving. Hospice staff members and volunteers offer warm professional support to help family members with emotional healing and readjustment. Hospice respects the natural dying process. It provides patients and family members with an opportunity for spiritual growth during this final phase of life.

Depression and Alzheimer's Disease

Do people who have Alzheimer's disease become depressed?

Yes. Depression is very common among people who have Alzheimer’s disease. In many cases, they become depressed when they realize that their memory and ability to function are getting worse.

Unfortunately, depression may make it even harder for a person who has Alzheimer’s disease to function, to remember things and to enjoy life.

How can I tell if my family member who has Alzheimer's disease is depressed?

It may be difficult for you to know if your family member is depressed. You can look for some of the typical signs of depression, which include the following:

 
  • Not wanting to move or do things (called apathy)
  • Expressing feelings of worthlessness and sadness
  • Refusing to eat and losing weight
  • Sleeping too much or too little
 
Other signs of depression include crying and being unusually emotional, being angry or agitated, and being confused. Your family member who has Alzheimer’s disease may refuse to help with his or her own personal care (for example, getting dressed or taking medicines). He or she may wander away from home more often.

Alzheimer’s disease and depression have many symptoms that are alike. It can be hard to tell the difference between them. If you think that depression is a problem for your relative who has Alzheimer’s disease, talk to his or her family doctor.

How can the doctor help?

The doctor will talk with your relative. The doctor will also ask you and other family members and caregivers whether the person has any new or changed behaviors. The doctor will check your relative and may wish to do some tests to rule out other medical problems. He or she may suggest medicines to help your family member feel better. The doctor may also have some advice for you and other family members and caregivers on how to cope. He or she may recommend support groups that can help you.
 

What medicines can help reduce depression?

Antidepressant medicines can be very helpful for people who have Alzheimer’s disease and depression. These medicines can improve the symptoms of sadness and apathy, and they may also improve appetite and sleep problems. Don’t worry–these medicines are not habit-forming. The doctor may also suggest other medicines that can help reduce upsetting problems, such as hallucinations or anxiety.

What can I do to help my family member?

Try to keep a daily routine for your family member who has Alzheimer’s disease. Avoid loud noises and overstimulation. A pleasant environment with familiar faces and mementos helps soothe fear and anxiety. Have a realistic expectation of what your family member can do. Expecting too much can make you both feel frustrated and upset. Let your family member help with simple, enjoyable tasks, such as preparing meals, gardening, doing crafts and sorting photos. Most of all, be positive. Frequent praise for your family member will help him or her feel better–and it will help you as well.

As the caregiver of a person who has Alzheimer’s disease, you must also take care of yourself. If you become too tired and frustrated, you will be less able to help your family member. Ask for help from relatives, friends and local community organizations. Respite care (short-term care that is given to the patient who has Alzheimer’s disease in order to provide relief for the caregiver) may be available from your local senior citizens’ group or a social services agency. Look for caregiver support groups. Other people who are dealing with the same problems may have some good ideas on how you can cope better and on how to make caregiving easier. Adult day care centers may be helpful. They can give your family member a consistent environment and a chance to socialize.

Where can I learn more about caring for my family member who has Alzheimer's disease?

A book called The 36-Hour Day explains Alzheimer’s disease and gives information about resources for caregivers. It gives ideas about things you can do to deal with behavior problems in an Alzheimer’s patient. One chapter discusses mood disorders and depression in these patients.
 

Depression and Older Adults:
What It Is and How to Get Help

What is depression?

Sometimes when people feel sad, they say they are “depressed.” But depression is more than just feeling sad. It’s a medical illness. Someone who has “major” depression has most or all of the symptoms listed in the box below nearly every day, all day, for 2 weeks or longer. There is also a “minor” form of depression that causes less severe symptoms. Both have the same causes and treatment.

Symptoms of depression

  • No interest or pleasure in things you used to enjoy, including sex
  • Feeling sad or numb
  • Crying easily or for no reason
  • Feeling slowed down or feeling restless and irritable
  • Feeling worthless or guilty
  • Change in appetite; unintended change in weight
  • Trouble recalling things, concentrating or making decisions
  • Headaches, backaches or digestive problems
  • Problems sleeping, or wanting to sleep all of the time
  • Feeling tired all of the time
  • Thoughts about death or suicide
 
 
Your body contains chemicals that help control your moods. When you don’t have enough of these chemicals or when your brain doesn’t respond to them properly, you may become depressed. Depression can be genetic (meaning it can run in families). Abusing drugs or alcohol can also lead to depression. Some medical problems and medications can lead to depression.

Depression is not a normal part of growing older, but it is common in adults age 65 and over. Retirement, health problems and the loss of loved ones are things that happen to older adults. Feeling sad at these times is normal. But if these feelings persist and keep you from your usual activities, you should talk to your doctor.

Why is depression in older adults hard to recognize?

It can be hard to tell the difference between depression and illnesses such as dementia. Also, older adults may not talk to their doctor about their sad or anxious feelings because they are embarrassed. But depression is nothing to be embarrassed about. It is not a personal weakness. It’s a medical illness that can be treated.
 

How is depression diagnosed?

Sometimes depression is first recognized by friends or family members. If you’re having symptoms of depression, be sure to tell your doctor. Don’t assume he or she will be able to tell that you are depressed just by looking at you. Your doctor will ask you questions about your symptoms, your health and your family’s history of health problems. He or she may also give you an exam and do some tests. It is also important to tell your doctor about any medicines that you are taking.

How is depression treated?

Depression can be treated with medicine or counseling, or with both. These treatments are very effective. Medicine may be particularly important for severe depression. Talk to your doctor about the right treatment for you.
 

What if my doctor prescribes medicine?

Medicines used to treat depression are called antidepressants. They correct the chemical imbalance in your brain that causes depression. These medicines usually work very well, but they may have some side effects. The side effects typically decrease with time. Antidepressants can start to work right away, but it may take 6 to 8 weeks before you see the full benefit. Don’t stop taking the medicine without checking with your doctor first.

What about suicide?

Thinking about suicide can be part of depression. Anyone with depression, including older adults, may be at risk for suicide. If you have thoughts about hurting yourself, tell your doctor, friends or family right away, or call your local suicide hot line (listed in your phone book). The thoughts of suicide will go away after the depression is treated.

Dementia: Info and Advice for Caregivers

What is dementia?

Dementia is a brain disorder that makes it hard for people to remember, learn and communicate. These changes eventually make it hard for people who have dementia to care for themselves. Dementia may also cause changes in mood and personality. Early on, lapses in memory and clear thinking may bother the person with dementia. Later, disruptive behavior and other problems can create a burden for caregivers and other family members.

Dementia is caused by the damage of brain cells. A head injury, stroke, brain tumor or disease (such as Alzheimer’s disease) can damage brain cells and lead to dementia.

How is dementia treated?

Some causes of dementia can be treated. However, once brain cells have been destroyed, they cannot be replaced. Treatment may slow or stop the loss of more brain cells. When the cause of dementia can’t be treated, the focus of care is on helping the person with his or her daily activities and reducing upsetting symptoms. Some medicines can help people who have dementia. Your family doctor will talk with you about treatment options.

Why do people who have dementia become agitated?

The agitation can have many causes. A sudden change in surroundings or frustrating situations can cause people who have dementia to become agitated. For example, getting dressed or giving the wrong answer to a question may cause frustration. Being challenged about the confusion or inability to do things caused by the dementia may also make the person agitated. As a result, the person may cry, become irritable, or try to hurt others in some way.

How can I deal with agitation?

One of the most important things you can do is avoid situations in which your loved one might become frustrated. Try to make your loved one’s tasks less difficult. For example, instead of expecting him or her to get dressed alone, you can just have your loved one put on one thing, such as a jacket, on his or her own.

You can also try to limit the number of difficult situations your loved one must face. For example, if taking a bath or shower causes problems, have him or her take one every other day instead of every day. Also, you can schedule difficult activities for a time of day when your loved one tends to be less agitated. It’s helpful to give frequent reassurance and avoid contradicting him or her.

What should I do if hallucinations are a problem?

If the hallucinations are not making your loved one scared or anxious, you don’t need to do anything. It’s better not to confront people about their hallucinations. Arguing may just upset a person who has dementia. If the hallucinations are scary to your loved one, you can try to distract the person by involving him or her in a pleasant activity.

What if my loved one will not go to sleep at night?

Try one or more of the following if your loved one is having trouble sleeping:

 
  • Try to make the person more aware of what time of day it is. Place clocks where he or she can see them.
  • Keep curtains or blinds open so that he or she can tell when it is daytime and when it is nighttime.
  • Limit the amount of caffeine he or she consumes.
  • Try to help your loved one get some exercise every day.
  • Don’t let him or her take too many naps during the day.
  • Make your loved one’s bedroom peaceful. It is easier to sleep in a quiet room.
  • At night, provide a night light or leave a dim light on. Total darkness can add to confusion.
  • If your loved one has arthritis or another painful condition that interrupts his or her sleep, ask your doctor if it is okay to give your loved one medicine for pain right before bed.

What if wandering becomes a problem?

Sometimes very simple things can help with this problem. It is all right for your loved one to wander in a safe place, such as in a fenced yard. By providing a safe place, you may avoid confrontation. If this doesn’t work, remind your loved one not to go out a certain door by placing a stop sign on it or putting a piece of furniture in front of it. A ribbon tied across a door can serve as a similar reminder. Hiding the doorknob by placing a strip of cloth over it may also be helpful.

An alarm system will alert you that your loved one is trying to leave a certain area. Your alarm system may just be a few empty cans tied to a string on the doorknob. You might have to place special locks on the doors, but be aware that such locks might be dangerous if a house fire occurs. Don’t use this method if your loved one will be left home alone. Make sure your loved one wears a medical bracelet, in case he or she does wander away from home.

Dementia: What Are the Common Signs?

What is dementia?

Dementia is a problem in the brain that makes it hard for a person to remember, learn and communicate. After a while, this makes it hard for the person to take care of himself or herself.

Dementia may also change a person’s mood and personality. At first, memory loss and trouble thinking clearly may bother the person who has dementia. Later, disruptive behavior and other problems may start. The person who has dementia may not be aware of these problems.

What causes dementia?

Dementia is caused by the destruction of brain cells. A head injury, a stroke, a brain tumor or a problem like Alzheimer’s disease can damage brain cells. Some people have a family history of dementia.

What if a family member has signs of dementia?

If your family member has some of the signs of dementia, try to get him or her to go see a doctor. You may want to go along and talk with the doctor before your relative sees him or her. Then you can tell the doctor about the way your relative is acting without embarrassing your relative.

What if I have any of these signs of dementia?

Talk with your doctor. Your doctor can do tests to find out if your signs are caused by dementia. The sooner you know, the sooner you can talk to your doctor about treatment options.

What are some common signs of dementia?

Dementia causes many problems for the person who has it and for the person’s family. Many of the problems are caused by memory loss. Some common signs of dementia are listed below. Not everyone who has dementia will have all of these signs.

 
  • Recent memory loss. All of us forget things for a while and then remember them later. People with dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.
  • Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
  • Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
  • Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
  • Poor judgment. Even a person who doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
  • Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
  • Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.
  • Changes in mood. Everyone is moody at times, but people with dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
  • Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
  • Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.

Grieving: Facing Illness, Death and Other Losses

What is grief?

Grief is a normal, healthy response to loss. One of the greatest losses that can occur is the death of someone you love. Other losses include the loss of your health or the health of someone you care about, or the end of an important relationship, such as a marriage. Healing from a loss involves coming to terms with the loss and the meaning of the loss in your life.

What are the normal feelings of grief?

  • Anger
  • Blaming yourself
  • Crying spells
  • Diarrhea
  • Dizziness
  • Fast heartbeat
  • Feeling like there’s a lump in your throat
  • Feeling like what’s happening around you isn’t real
  • Headaches
  • Hyperventilating — sighing and yawning
  • Nausea
  • Not being able to get organized
  • Not feeling hungry or losing weight
  • Restlessness and irritability
  • Sadness or depression
  • Seeing images of the dead person
  • Shortness of breath
  • Tightness in your chest
  • Tiredness
  • Trouble concentrating
  • Trouble sleeping
As you face a loss, you may have different feelings at different times. These feelings include shock, denial, anger, guilt, sadness and acceptance. You may find yourself going back and forth from one feeling to another. For example, right when it seems that you’re starting to accept your loss, you may find yourself feeling sad or guilty again. Your grief may never completely go away. But the pain you feel will lessen with time as you work through these feelings.

What usually happens first?

In the first hours or days after the loss, you may feel shocked, numb and confused. You may not remember what people have said to you. You may think and act as though the loss hasn’t occurred. This is called denial.

As the shock wears off, reality will slowly break through. You’ll begin to realize that the loss has happened. It’s normal to feel abandoned and angry. You may direct your anger toward God, religion, doctors and nurses, the one who has died or other loved ones, or even yourself.

What happens after the anger wears off?

After you get through some of the anger and denial, it’s normal to pretend things are like they used to be. If someone you love has died, you may play memories over and over in your mind. You may also feel the presence of your loved one, think you see him or her, or think you hear his or her voice.

You may also find yourself talking to your loved one as though he or she were in the room with you. As you begin to realize that your loved one is gone and won’t be back, you’ll begin to feel the full impact of your loss. These feelings may be scary because they’re so strange and so strong. They may make you feel like you’re losing control.

What happens then?

When you begin to realize the full impact of the loss on your life, you may feel depressed and hopeless. You may also feel guilty. You may find yourself thinking things like “if only” or “why me?” You may cry for no apparent reason. This is the most painful stage of healing, but it won’t last forever. In normal grief, the depression will begin to lift with time.
 

What is the first sign of relief?

You may start to feel better in small ways. For example, you may find it’s a little easier to get up in the morning, or you may have small bursts of energy. This is the time when you’ll begin to reorganize your life around your loss or without your loved one.

What is the final stage?

  • Talk about how you’re feeling with others.
  • Try to keep up with your daily tasks so you don’t feel overwhelmed.
  • Get enough sleep, eat a well-balanced diet and exercise regularly.
  • Avoid alcohol. Alcohol can make you feel more depressed.
  • Get back into your normal routine as soon as you can.
  • Avoid making major decisions right away.
  • Allow yourself to grieve–to cry, to feel numb, to be angry or to feel however you’re feeling.
  • Ask for help if you need it.
The last stage of accepting a loss is when you begin to reinvest in other relationships and activities. During this time, it’s normal to feel guilty or disloyal to your loved one because you’re moving on to new relationships. It’s also normal to relive some of your feelings of grief on birthdays, anniversaries, holidays and during other special times.

How long does grief last?

You’ll probably start to feel better in 6 to 8 weeks. The whole process can last anywhere from 6 months to 4 years.

If you feel like you’re having trouble at any point, ask for help. People who can help include friends, family, clergy, a counselor or therapist, support groups and your family doctor.

Be sure to talk with your family doctor if you have a lot of trouble eating, sleeping or concentrating for more than the first couple of weeks. These can be signs of depression. Your family doctor can help you with depression so you can start to feel better.

Caregiver Stress

Who is a caregiver?

You’re a caregiver if you give basic care to a person who has a chronic medical condition. A chronic condition is an illness that lasts for a long period of time or doesn’t go away. Some examples of chronic conditions are cancer, stroke, multiple sclerosis, dementia, diabetes and Alzheimer’s disease.

If you’re a caregiver, you may be doing the following things for another person:
  • Lifting
  • Turning him or her in bed
  • Bathing
  • Dressing
  • Feeding
  • Cooking
  • Shopping
  • Paying bills
  • Running errands
  • Giving medicine
  • Keeping him or her company
  • Providing emotional support

Why is caregiving so hard?

The person you’re caring for may not know you anymore. He or she may be too ill to talk or follow simple plans. This may make it hard for you to think of that person in the same way that you did before he or she became ill. This may be especially true if the person you’re caring for suffers from dementia.

The person you’re caring for may also have behavior problems, like yelling, hitting or wandering away from home. This behavior may make you feel angry and frustrated.

How can I tell if caregiving is putting too much stress on me?

Common signs of caregiver stress include the following:
  • Feeling sad or moody
  • Crying more often than you used to
  • Having low energy level
  • Feeling like you don’t have any time to yourself
  • Having trouble sleeping, or not wanting to get out of bed in the morning
  • Having trouble eating, or eating too much
  • Seeing friends or relatives less often than you used to
  • Losing interest in your hobbies or the things you used to do with friends or family
  • Feeling angry at the person you are caring for or at other people or situations
 
In addition, you may not get any thanks from the person you are caring for. This may add to your feelings of stress and frustration.

What should I do if I'm feeling overwhelmed and stressed?

These feelings are not wrong or strange. Caregiving can be very stressful. Because being a caregiver is so hard, some doctors think of caregivers as “hidden patients.” If you don’t take care of yourself and stay well, you won’t be able to help anyone else.

Talk with your family doctor about your feelings. Stay in touch with your friends and family members. Ask them for help in giving care. Asking for help doesn’t make you a failure.

Look for help in your community. You may start by asking your church or synagogue if they have services or volunteers who can help you. You can also ask for help from support organizations (see “Other Organizations”).

Autopsy

What is an autopsy?

An autopsy is a medical exam of the body of a person who has died. The purpose of an autopsy is to answer questions about the person’s illness or the cause of death. In addition, autopsies provide valuable information that helps doctors save the lives of others. Autopsies are performed by specially trained doctors, called pathologists.

Who may request an autopsy?

You can request an autopsy if you are the person’s next of kin or the legally responsible party. Your doctor will ask you to sign a consent form to give permission for the autopsy. You may limit the autopsy in any manner you wish.

However, if the cause of death is unclear, the pathologist may perform an autopsy without the family’s permission.

What is the procedure for an autopsy?

First, the pathologist looks at the body for clues about the cause of death. Next, he or she examines the internal organs, taking samples as needed to look at under a microscope. The autopsy takes from 2 to 4 hours. The autopsy room looks similar to an operating room. An atmosphere of dignity and respect for the deceased is maintained at all times.
 

What does an autopsy cost?

If the autopsy is performed by family request, the cost is between $5000 & $8000 and is paid prior to the procedure.

Will an autopsy interfere with funeral arrangements?

No. Pathologists perform autopsies in a way that doesn’t interfere with burial or cremation. Once the autopsy is completed, the hospital tells the funeral home. An autopsy won’t delay funeral services.

When will the results of an autopsy be known?

The first findings from an autopsy are usually ready in 2 to 3 days. The doctor can review these results with you. A final report may take many weeks because of the detailed studies performed on tissue samples. The doctor will also review the final report with you.
 

Pressure Sores

What are pressure sores?

Pressure sores are areas of injured skin and tissue. They are usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. The pressure can reduce the blood supply to the skin and the tissues under the skin. When a change in position doesn’t occur often enough and the blood supply gets too low, a sore may form. Pressure sores are also called bedsores, pressure ulcers and decubitus ulcers.

Are pressure sores serious?

Pressure sores can be serious, depending on how much the skin and tissues have been damaged. You should call your doctor if you think a sore is forming.

Mild damage causes the skin to be discolored, but a sore doesn’t form. In light-skinned people, the damaged skin may turn dark purple or red. In dark-skinned people, the area may become darker than normal. The area of damaged skin may also feel warmer than the surrounding skin.

Deep sores can go down into the muscle, or even to the bone. If pressure sores are not treated properly, they can become infected. An infection in a pressure sore can be serious. Pressure sores also hurt a lot and make it hard for a person to move around.

Who gets pressure sores?

Anyone who sits or lies in one position for a long time might get pressure sores. You are more likely to get pressure sores if you use a wheelchair or spend most of your time in bed. However, even people who are able to walk can get pressure sores when they must stay in bed because of an illness or injury. Some chronic diseases, such as diabetes and hardening of the arteries, make it hard for pressure sores to heal because of a poor blood supply to the area.

Where on the body can you get pressure sores?

Pressure sores usually develop over bony parts of the body that don’t have much fat to pad them. Pressure sores are most common on the heels and on the hips. Other areas at risk for pressure sores include the base of the spine, the shoulder blades, the backs and sides of the knees, and the back of the head.

How are pressure sores treated?

Three things help pressure sores heal:

  • Relieving the pressure that caused the sore
  • Treating the sore itself
  • Improving nutrition and other conditions to help the sore heal

What can be done to reduce pressure on the sore?

Don’t lie on pressure sores. Use foam pads or pillows to take pressure off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support you in bed or in a chair to reduce or relieve pressure. Try to avoid resting directly on your hip bone when you’re lying on your side. Use pillows under one side so that your weight rests on the fleshy part of your buttock instead of on your hip bone. Also, use pillows to keep your knees and ankles apart. When lying on your back, place a pillow under your lower calves to lift your ankles slightly off the bed. Change your position at least every 2 hours.

When sitting in a chair or wheelchair, sit upright and straight. An upright, straight position will allow you to move more easily and help prevent new sores. If you cannot move by yourself, have your caregiver shift your position at least every hour, or more often if possible.

How should the pressure sore be kept clean?

In order to heal, pressure sores must be kept clean and free of dead tissue. You can clean the sore by rinsing the area with a salt-water solution. The salt water removes extra fluid and loose material. Your doctor or nurse can show you how to clean your pressure sore.

Pressure sores should be kept covered with a bandage or dressing. Sometimes gauze is used. The gauze is kept moist and must be changed at least once a day. Newer kinds of dressings include a see-through film and a hydrocolloid dressing. A hydrocolloid dressing is a bandage made of a gel that molds to the pressure sore. These dressings can stay on for several days at a time.

Dead tissue (which may look like a scab) in the sore can interfere with healing and lead to infection. There are many ways to remove dead tissue from the pressure sore. Rinsing the sore every time you change the bandage is helpful. Special dressings that help your body dissolve the dead tissue can also be used. They are left in place for several days.

Another way to remove dead tissue is to put wet gauze bandages on the sore and allow them to dry. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. Sometimes dead tissue must be removed surgically.

Removing dead tissue and cleaning the sore can hurt. Your doctor can suggest a pain reliever for you to take 30 to 60 minutes before your dressing is changed.

Why is good nutrition important for healing sores?
Good nutrition is important because it helps your body heal the sore. If you don’t get enough calories, protein and other nutrients, your body won’t be able to heal, no matter how well you care for the pressure sore. Your doctor or nurse or a dietitian can give you advice about a healthy diet. Be sure to tell your doctor if you have lost or gained weight recently.

What if the sore gets infected?

Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of your body. If you notice any of the signs of infection listed below, call your doctor right away.

Signs of an infected pressure sore include the following:

 
  • Thick yellow or green pus
  • A bad smell from the sore
  • Redness or warmth around the sore
  • Swelling around the sore
  • Tenderness around the sore
 
Signs that the infection may have spread include the following:
  • Fever or chills
  • Mental confusion or difficulty concentrating
  • Rapid heartbeat
  • Weakness

How are infected pressure sores treated?

The treatment of an infected pressure sore depends on how bad the infection is. If only the sore itself is infected, an antibiotic ointment can be put on the sore. When bone or deeper tissue is infected, intravenous antibiotics (given through a needle put in a vein) are often required.
 

How can I tell if the sore is getting better?

As a pressure sore heals, it slowly gets smaller. Less fluid drains from it. New, healthy tissue starts growing at the bottom of the sore. This new tissue is light red or pink and looks lumpy and shiny. It may take 2 to 4 weeks of treatment before you see these signs of healing.
 

How can pressure sores be prevented?

The most important step to prevent pressure sores is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously.

It’s also important to keep your skin healthy. Keep your skin clean and dry. Use a mild soap (like Dove, Basis or Oil of Olay) and warm (not hot) water. Apply moisturizers so your skin doesn’t get too dry. If you must spend a lot of time in bed or in a wheelchair, check your whole body every day for spots, color changes or other signs of sores. Pay special attention to the pressure points where sores are most likely to occur.

Cancer: End-of-Life Issues for the Caregiver

Not everyone who has cancer succumbs to the disease. In fact, there are nearly 9 million cancer survivors living in the United States today. However, if your loved one’s cancer cannot be cured or controlled with treatment, then planning for how you and your loved one will handle the last stages of the disease can ease the burden for both of you. Ideally, you should make these decisions together, while your loved one is well enough to participate. Doing so can help give your loved one a sense of control over his or her future and relieve you from having to make difficult decisions on your own.

What kinds of things should we plan for?

Hospice care: Talk with your loved one about hospice care and advanced directives. Hospice care focuses on providing people whose illness can’t be cured or controlled with treatment with the most dignified, pain-free existence possible in their last stage of life. Advance directives are instructions on what kind of care your loved one wishes to receive when he or she becomes unable to make medical decisions.

Financial and legal issues: You and your loved one may wish to have an accountant or lawyer help you sort through financial and legal issues. You can review things such as your loved one’s insurance policy, finances and his or her will.

Funeral arrangements: Perhaps the most difficult part of this process is planning your loved one’s funeral. Talk with your loved one about his or her preferences (for example, burial vs. cremation) in relation to your budget. Ask your loved one how he or she wants the service to be conducted. For example, you may want to discuss things such as what hymns or readings to include in the ceremony and whom your loved one wants to have as his or her pallbearers. Don’t feel that any detail is too small to discuss. When selecting a funeral provider, be sure to compare prices, services and payment options. It will be easier to do this sooner rather than later.

Pain Control After Surgery: Pain Medicines

What are the benefits of taking pain medicine after surgery?

People used to think they just had to put up with severe pain after surgery. Today, your nurses and doctors can do many things before and after surgery to prevent or relieve your pain. Treatment of pain can help you in the following ways:
  • You can feel more comfortable, which will help your body heal.
  • You can get well faster. If you feel less pain, you can start walking and get your strength back more quickly. You may even leave the hospital sooner.
  • You may have fewer complications after surgery. People whose pain is well-controlled seem to do better after surgery. For example, they don’t have as many problems such as pneumonia and blood clots.
 
Many types of medicines are available to help control pain. Some of these include nonsteroidal anti-inflammatory drugs (called NSAIDs), opioids and local anesthetics.

When are NSAIDs used?

For mild pain after surgery, you might be given NSAIDs. These medicines reduce swelling and soreness, and relieve mild to moderate pain. Some examples of these medicines are aspirin and ibuprofen (one brand name: Motrin).
 

What are the benefits of NSAIDs?

You won’t get addicted to these medicines. Depending on how much pain you have, these medicines can take it away or at least lessen your need to take a stronger medicine, such as morphine.
 

What are the problems with NSAIDs?

Most NSAIDs get in the way of blood clotting. They may also cause nausea, stomach bleeding or kidney problems. If your pain is strong, you will usually also have to take an opioid.
 

When are opioids used?

Opioids such as morphine and codeine are the medicines most often used for acute pain, such as short-term pain after surgery.
 

What are the benefits of opioids?

Opioids work well for severe pain. They don’t cause bleeding in the stomach or other parts of the body. It’s rare to become addicted to opioids after surgery if it’s used as prescribed by your doctor.
 

What are the problems with opioids?

Opioids may cause drowsiness, nausea, constipation or itching. They can also interfere with breathing or urination.
 

What about local anesthetics?

Local anesthetics, such as bupivacaine, can be given in a shot near your incision or through a small tube in your back. These medicines block the nerves that send pain signals to your brain.
 

What are the benefits of local anesthetics?

Local anesthetics, or shots at the incision, will block pain only at that area of the body. There is little or no risk of drowsiness, constipation or breathing problems when you use a local anesthetic. Local anesthetics reduce your need for opioids.
 

What are the problems with local anesthetics?

Several shots are needed to keep the pain relief going, but too much of a local anesthetic can cause problems. Even average doses may cause you to feel dizzy or make your legs feel weak.
 

How is pain medicine given?

Medicines can be given by mouth (liquid or pill) or through the rectum (suppository), or they can be injected into the skin, a muscle or a vein.
 

What are the benefits and problems of oral medicines?

Aspirin, ibuprofen or codeine can be taken by mouth. Pills and liquids cause less discomfort than shots into a muscle or the skin. They can work just as well as shots. They are inexpensive and easy for you to take when you go home from the hospital. On the other hand, these medicines can’t be used if you aren’t supposed to take anything by mouth or if you’re nauseated or vomiting. (Some of these medicines also come in a rectal suppository, so you can take them even if you’re nauseated.) There may be a delay in pain relief with oral medicines, because you have to ask for the medicine and wait for it to be brought to you.
 

What are the benefits and problems of injected medicines?

Medicines given in shots into the skin or a muscle can work even if you’re nauseated or vomiting. However, the injection site usually hurts for a short time.

Pain relief medicines can be injected into a vein through a small tube called an intravenous (IV) catheter. The tip of the tube stays in your vein all the time that the medicine is being used. Medicine given this way goes through your body fast, so it starts to work quickly. This method of pain relief works well for brief pain.

With a patient-controlled analgesia (PCA) pump, you can control your own doses of pain medicine. When you begin to feel pain, you push a button to inject medicine into your vein; a small tube must first be put into your vein. If you use the PCA pump, you have to learn how to use it and when to use it.

Pain medicine can also be put into your back through a small tube called an epidural catheter. This method works well when you’re having surgery on your chest or your stomach. It takes a specially trained doctor, called an anesthesiologist, to put the small tube in your back. This person also watches you for problems that can happen several hours after the pain medicine is given.

End-of-Life Care: Cardiopulmonary Resuscitation (CPR)

When is CPR important?

CPR may be done when a person stops breathing or the heart stops beating (like when a person has a heart attack). When it’s possible that the person may get better, CPR is important.

However, when a patient has an advanced life-threatening illness (such as cancer) and is dying, CPR may not be the option to choose. It’s important for the patient, family members and doctor to talk about this issue before the need arises.

What happens during CPR?

During CPR, the chest is pressed on forcefully. Electric stimulation to the chest and special medicines are sometimes used. This is usually done for 15 to 30 minutes. A tube may also be put through the mouth or nose into the lung. This tube is then connected to a breathing machine.

What happens if CPR isn't done?

A person will become unconscious almost immediately and will die in 5 to 10 minutes.
 

What are the benefits of CPR?

For a patient with an advanced life-threatening illness who is dying, there are really no benefits.

CPR may prolong life for patients with a better health status or who are younger. CPR may also prolong life if it’s done within 5 to 10 minutes of when the person’s heart stopped beating or breathing stopped.

What are the risks of CPR?

Pressing on the chest can cause a sore chest, broken ribs or a collapsed lung. Patients with breathing tubes usually need medicine to keep them comfortable. Most patients who survive will need to be on a breathing machine in the intensive care unit to help them breathe for a while.

Few patients (less than 10 percent) in the hospital who have had CPR survive and are able to function the way they used to. Many patients live for a short time after CPR, but still die in the hospital. CPR may also prolong the dying process.

Patients who have more than one illness usually don’t survive after CPR. Almost no one with advanced cancer survives CPR and lives long enough to leave the hospital. Of the few patients who do, many get weaker or have brain damage. Some patients may need to live on a breathing machine for the rest of their lives.

Artificial Hydration

What is artificial hydration?

Artificial hydration is a way to replace fluids that have been lost through vomiting, sweating or diarrhea. It may be necessary when a person is too sick to drink enough water or eat enough food.

Why do our bodies need fluid?

Our bodies are made mostly of water. Almost 60 percent of our body weight comes from water. In order to be healthy, the body needs water just as it needs food. We lose water everyday in two ways: by going to the bathroom (about 45 ounces a day) and by sweating and breathing (at least 21 ounces a day). We have to eat food and drink fluids every day to get the amount of water our bodies need.
 
 

How are fluids replaced?

There are two ways to replace fluids in someone who needs them. The first way is to put the fluid right into a vein. This is called intravenous (IV) fluid replacement. The other way is to put the fluid under the skin. This is called hypodermoclysis, or subcutaneous fluid replacement.

With IV fluid replacement, doctors and nurses need to watch the person very closely in a hospital. But a family member or other caregiver can do hypodermoclysis at home after a doctor or nurse shows him or her how to do it.

How safe is hypodermoclysis?

This way of replacing fluid has been used safely for many years. It is used most often on older people and in people who have cancer.
 

How does hypodermoclysis work?

A bag of fluid is connected to a plastic tube and to a long needle. The needle is put under the skin and taped in place, usually on the chest, abdomen or thighs.

A “drip chamber,” or small window, in the tube shows how fast the fluid is dripping. The speed of the drip can be controlled by using a roller clamp. A nurse or doctor should replace the needle every 4 to 7 days so the flesh around the needle does not become infected.

Your doctor will decide how fast the fluid should drip. Your doctor will show you how to control the drip and tell you when to check it at home. You can ask your doctor for help if you have questions or problems.

What are the common problems with hypodermoclysis and what should I do?

Most of the time, hypodermoclysis is safe. Sometimes though, there can be problems. Here are a few things that might happen during hypodermoclysis:

 
  1. The speed of the drip changes or the drip stops. Your doctor will show you how to control the flow rate by rolling the roller clamp.
  2. The site where the needle is inserted will swell. If you gently rub the skin there, the fluid will soak in better. Your doctor will show you how. Call your doctor for help if the swelling continues or does not get better.
  3. The site where the needle is inserted becomes painful. Check the skin for redness. Tell your doctor if the skin is red. It may be time to find a different place to insert the needle.
  4. Blood collects in the tube. This means the needle has gone into a vein. Call your doctor if this happens.
  5. The person has trouble breathing or is feeling much worse. If this is the case, call your doctor.

Artificial Hydration and Nutrition

When do people need artificial hydration and nutrition?

If a patient isn’t able to swallow because of a medical problem, he or she can be given fluids and nutrition in ways other than by mouth. This is referred to as artificial hydration and nutrition. This is sometimes done when someone is recovering from a temporary problem. It may also be done when someone has an advanced, life-threatening illness and is dying.

What is involved in artificial nutrition and hydration?

An intravenous (IV) catheter (a thin plastic tube that slides in over a needle) may be placed in the vein under the patient’s skin. Fluids and sometimes nutrition are given through the catheter.

Another method of artificial nutrition and hydration is through a plastic tube called a nasogastric tube (also called an NG tube). This tube is put through the nose, down the throat and into the stomach. It can only be left in for a short time, usually 1 to 4 weeks. If the tube has to be in longer, a different kind of feeding tube may be used. It’s placed into the wall of the stomach (also called a PEG tube or g-tube).
 

What happens if artificial hydration or nutrition are not given?

Persons who don’t receive any food or fluids will eventually fall into a deep sleep (coma) and usually die in 1 to 3 weeks.
 

What are the benefits?

A person with a temporary illness who can’t swallow needs nutrients and water. A feeding tube can help. Sometimes a person may become confused because of dehydration. Dehydration is when the body doesn’t get enough fluids. Giving a patient fluids through a tube help dehydration and may lessen his or her confusion. Giving fluids and nutrition helps the patient as he or she is recovering.

For a patient with an advanced life-threatening illness who is dying, artificial hydration and nutrition may not provide many benefits. Artificial hydration and nutrition in these patients may make the patient live a little longer, but not always.

What are the risks?

There’s always a risk when someone is fed through a tube. Liquid might enter the lungs. This can cause coughing and pneumonia. Feeding tubes may feel uncomfortable. They can become plugged up, causing pain, nausea and vomiting. Feeding tubes may also cause infections. Sometimes, patients may need to be physically restrained or sedated to keep them from pulling out the feeding tube.

How do we decide whether to use artificial hydration and nutrition?

The patient and his or her family should talk with the doctor about the patient’s medical condition and risks and benefits of giving artificial hydration and nutrition. Each situation is different. Your doctor can help you make the decision that is right for the patient and family
 

Advance Directives and Do Not Resuscitate Orders

What is an advance directive?

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives.

A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don’t want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are.

Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.

What is a living will?

A living will is one type of advance directive. It is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn’t let you select someone to make decisions for you.
 

What is a durable power of attorney for health care?

A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. But a DPA may not be a good choice if you don’t have another person you trust to make these decisions for you.

Living wills and DPAs are legal in most states. Even if they aren’t officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.

What is a do not resuscitate order?

A do not resuscitate (DNR) order is another kind of advance directive. A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don’t want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.

Should I have an advance directive?

By creating an advance directive, you are making your preferences about medical care known before you’re faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.

People who are seriously or terminally ill are more likely to have an advance directive. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control over her death. However, even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.

How can I write an advance directive?

You can write an advance directive in several ways:

 
  • Use a form provided by your doctor.
  • Write your wishes down by yourself.
  • Call your health department or state department on aging to get a form.
  • Call a lawyer.
  • Use a computer software package for legal documents.
 
Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can’t speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

Can I change my advance directive?

You may change or cancel your advance directive at any time, as long as you are considered of sound mind to do so. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. Again, your changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.

If you do not have time to put your changes in writing, you can make them known while you are in the hospital. Tell your doctor and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. Be sure your instructions are clearly understood by everyone you have told.

How to Get the Most from Your Medicine

What do I need to know?

Medicines can help you feel better. But if medicines are taken incorrectly, they can actually make you feel worse. To use prescription medicines and medicines you can buy “over-the-counter” (without a prescription) correctly, follow the guidelines below.

What questions should I ask my doctor about my medicines?

People who have RLS say it’s difficult to describe their symptoms. If you have RLS, you may have a “creepy-crawly” feeling in your legs that makes you want to move around. You may experience achy, tingly or burning sensations in your legs, which can make it difficult to sleep or sit for long periods of time. Moving your legs makes the feeling go away for a few minutes, but it comes back after you sit or lie still again. Your legs may also twitch when you try and sleep (also called periodic limb movements of sleep or PLMS).
 

How does my doctor know I have RLS?

If there is something you don’t understand about a medicine you’re taking, ask your doctor. If you still don’t understand, ask your doctor to explain things more clearly. If you are taking more than one medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together (called a drug interaction).

Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely:

 
  • What does the medicine do?
  • When and how should I take the medicine?
  • What side effects (reactions your body may have to the medicine) could I have?
  • Will the medicine react to any other medicines, foods or drinks?
  • Should I avoid any activities while I’m taking the medicine?
  • What should I do if I forget to take the medicine?
  • How will I know whether the medicine is working?

Things to know about each medicine you take

  • Name (generic name and brand name)
  • Reason for taking it
  • How much to take and how often to take it
  • Possible side effects and what to do if you have them
  • How long to continue taking it
  • Special instructions (taking it at bedtime or with meals, etc.)

How can I remind myself to take my medicine?

Make your medicine part of your daily routine by taking it at the same time (or times) every day, such as when you wake up or with meals. Keep the medicine bottle(s) in a place you see often, such as on the kitchen counter. (Make sure that medicines are in childproof containers and kept out of the reach of children.)

Should I avoid any foods, drinks or activities while I'm taking medicine?

Talk to your doctor about things to avoid while you are taking a prescription medicine. Some foods can cause side effects, such as stomach upset, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun.

If you are taking an over-the-counter medicine, read the label to see what to avoid while you are taking it. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist.

Medicine do's and don'ts

  • Do read the label carefully.
  • Do take your medicine exactly as your doctor tells you to.
  • Do make sure that each of your doctors (if you see more than one) has a list of all of the medicines you’re taking
  • Do ask your doctor to help you make a schedule (if you are taking more than one medicine) so you know what medicines to take at what times of the day.
  • Do consider using one pharmacy for all your prescriptions. The pharmacist can help you keep track of what you’re taking.
  • Do make sure everyone you live with knows what medicine you’re taking and when you’re supposed to take it.
  • Don’t combine prescription medicines and over-the-counter medicines unless your doctor says it’s OK.
  • Don’t stop taking a medicine or change how much you take or how often you take it without first talking to your doctor.
  • Don’t take someone else’s medicine.
  • Don’t use medicine after its expiration date.
  • Don’t crush, break or chew tablets or capsules unless your doctor tells you to. Some medicines won’t work correctly unless they are swallowed whole.

What's the difference between generic and brand name medicines?

Just like foods, some medicines come in both brand names and generics. Generic medicines are generally cheaper. Ask your doctor or pharmacist if a generic form of your prescription medicine will work for you.

Over-the-counter (OTC) medicines also come in generics. Compare the lists of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: The generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions about which medicine to choose.

Tips for choosing OTC medicines

  • If you have questions, ask your doctor or pharmacist.
  • Although it can seem overwhelming, take the time to look at all the choices.
  • Read the label carefully, and note what symptoms the medicine will treat.
  • Look for a medicine that will treat only the symptoms you have. For example, if you have only a runny nose, don’t pick a medicine that also treats coughs and headaches.
  • Note how much medicine you should take and what side effects it may cause.
  • Note what medicines or foods you should not take with the medicine.
  • Check to see if the medicine causes problems for people with certain health problems (such as asthma or high blood pressure).

What if I don't feel better even though I'm taking my medicine?

Any medicine needs time to work. When you are given a prescription, ask your doctor how long it should take for the medicine to make you feel better. It might take time to find the correct medicine for you and the correct amount of it. Call your doctor if you have concerns about what you’re taking or if you don’t feel better after taking your medicine as prescribed.
If you’re trying to treat yourself with an over-the-counter medicine and it doesn’t seem to be working, call your doctor. Your sickness can get much worse if you wait too long to get treated by your doctor.

Food-Drug Interactions

What is a drug-food interaction?

A drug-food interaction happens when the food you eat affects the ingredients in a medicine you are taking so the medicine cannot work the way it should.

Drug-food interactions can happen with both prescription and over-the-counter medicines, including antacids, vitamins and iron pills.

Are all medicines affected by food?

Not all medicines are affected by food, but many medicines can be affected by what you eat and when you eat it. For example, taking some medicines at the same time that you eat may interfere with the way your stomach and intestines absorb the medicine. The food may delay or decrease the absorption of the drug. This is why some medicines should be taken on an empty stomach (1 hour before eating or 2 hours after eating).

On the other hand, some medicines are easier to tolerate when taken with food. Ask your doctor or your pharmacist whether it’s okay to take your medicine with a snack or a meal or whether it should be taken on an empty stomach.

Facts to remember about drug-food interactions

  • Read the prescription label on the container. If you don’t understand something, ask your doctor or pharmacist.
  • Read all directions, warnings and interaction precautions printed on medicine labels and packages. Even over-the-counter medicines can cause problems.
  • Take medicine with a full glass of water, unless your doctor tells you differently.
  • Don’t stir medicine into your food or take capsules apart (unless your doctor tells you to) because this may change the way the drug works.
  • Don’t take vitamin pills at the same time you take medicine because vitamins and minerals can cause problems if taken with some drugs.
  • Don’t mix medicine into hot drinks because the heat may keep the drug from working.
  • Never take medicine with alcoholic drinks.

Drug-Food Interactions: How Grapefruit Interacts with Certain Drugs

What is a drug-food interaction?

A drug-food interaction happens when the food you eat or drink affects the ingredients in a medicine you are taking so the medicine can’t work the way it should.

Drug-food interactions can happen with both prescription and over-the-counter medicines, including antacids, vitamins and iron pills.

How does grapefruit interact with medicines?

Eating grapefruit or drinking grapefruit juice can cause higher levels of some medicines in your body, making it more likely that you will have side effects from the medicine.

Interactions can happen up to 3 days after eating or drinking grapefruit. This means you cannot drink grapefruit juice in the morning and take your medications later in the day to stop possible medicine interactions.

Do all medicines interact with grapefruit?

Only some medicines interact with grapefruit. Examples include medicines for:

  • High cholesterol: atorvastatin (one brand: Lipitor) and simvastatin (one brand: Zocor)
  • High blood pressure: felodipine (one brand: Plendil), nifedipine (one brand: Procardia), and nisoldipine (one brand: Sular)
  • Heart arrhythmia (when your heartbeat isn’t normal): amiodarone (one brand: Cordarone) and disopyramide (one brand: Norpace)
If you don’t know if the medicine you are taking interacts with grapefruit, ask your doctor or pharmacist. Your doctor usually can prescribe another medicine that doesn’t interact with grapefruit.

Do all fruit juices interact with medicines?

All other fruit juices, even other citrus juices, are safe to drink when taking medicine. There is no proof that these other juices interact with medicines.

What if I take a medicine that interacts with grapefruit?

An interaction can occur even if you eat or drink a small amount of grapefruit. However, if you like grapefruit and want to continue to enjoy it, ask your doctor if there is a different medicine for you that doesn’t interact with grapefruit.

Drug Reactions

What is an adverse drug reaction?

Medicines can treat or prevent illness and disease. However, sometimes medicines can cause problems. These problems are called adverse drug reactions. You should know what to do if you think that you or someone you take care of is having an adverse drug reaction.

Can adverse drug reactions happen to everyone?

Yes. Anybody can have an adverse drug reaction. However, people who take more than 3 or 4 medicines every day are more likely to have an adverse drug reaction. One medicine might cause an adverse reaction if its taken with another medicine.

One way to reduce your chances of having adverse drug reactions is to work with your doctor to limit the number of medicines you take. Tell your doctor about all of the medicines you’re taking, even if you take something for only a short time. You may also want to use only one drugstore so your pharmacists get to know you and the medicines you take. Pharmacists are trained to look at the medicines you’re taking to see whether they might cause an adverse drug reaction.

Are prescription medicines the only cause of adverse reactions?

No. Even medicines that don’t need a prescription (called over-the-counter medicines) can interact with each other or with prescription drugs and cause problems. Supplements, herbal products in teas or tablets, or vitamins may also cause adverse reactions when taken with certain drugs. Be sure to tell your doctor and pharmacist if you’re using any of these products.

Some types of food may also cause adverse drug reactions. For example, grapefruit and grapefruit juice, as well as alcohol and caffeine, may affect how drugs work. Every time your doctor prescribes a new drug, ask about possible interactions with any foods or beverages.

What about medicines I've used in the past?

You might be tempted to save money by taking old medicines that you’ve used before. However, it’s likely that you are taking different medicines now than you were when you were taking the old drug. Even though you didn’t have an adverse reaction with the old medicine before, you might have a bad reaction when you take it with the medicines you’re taking now.

Is it safe to use a friend or relative's medicine?

No. Using medicines that were prescribed for a friend or relative can cause problems and might lead to adverse drug reactions because:
 
  • Your doctor prescribes medicine according to your size, gender and age. The wrong amount of medicine may cause adverse reactions.
  • The medicines you’re taking are probably different from the medicines the other person takes. This different combination of drugs may also cause an adverse reaction.
  • You might react differently to the medicine than the other person did.
To be safe, never share medicines with anybody.

How will I know I'm having an adverse drug reaction?

When you’re taking any medicine, it’s important to be aware of any change in your body. Tell your doctor if something unusual happens.

It may be hard to know if an adverse reaction is caused by your illness or by your medicine. Tell your doctor when your symptoms started and whether they are different from other symptoms you have had from an illness. Be sure to remind your doctor of all the medicines you are taking. The following are some adverse drug reactions that you might notice:
 
  • Skin rash
  • Easy bruising
  • Bleeding
  • Severe nausea and vomiting
  • Diarrhea
  • Constipation
  • Confusion
  • Breathing difficulties
The following are some adverse reactions your doctor might notice during a check-up:
  • Changes in lab test results
  • Abnormal heartbeat

What will my doctor do if I have an adverse drug reaction?

Your doctor might tell you to stop taking the medicine so the adverse reaction will go away by itself. Or your doctor might have you take another medicine to treat the reaction. If your adverse reaction is serious, you might have to go to a hospital. Never stop taking a medicine on your own; always talk with your doctor first.

Pain Relievers: Understanding Your OTC Options

What types of OTC pain relievers are available?

Over-the-counter (OTC) pain relievers are medicines that you can buy without a prescription from your doctor. Two main types of OTC pain relievers are available. One type is acetaminophen (brand name: Tylenol). The second type is nonsteroidal anti-inflammatory drugs (also called NSAIDs). NSAIDs include the following:
 
  • Aspirin (two brand names: Bayer, St. Joseph)
  • Ibuprofen (two brand names: Advil, Motrin)
  • Ketoprofen (one brand name: Orudis KT)
  • Naproxen (one brand name: Aleve)
Some products contain both acetaminophen and aspirin (brand names: Excedrin Extra Strength, Excedrin Migraine, Vanquish).

How do pain relievers work?

Acetaminophen seems to relieve pain and reduce fever by working on the parts of the brain that receive pain messages and control the body’s temperature.

NSAIDs relieve pain and fever by reducing the level of hormone-like substances (called prostaglandins) that your body makes. These substances cause the feeling of pain by irritating your nerve endings. They also are part of the system that helps your body control its temperature.

What types of problems can OTC pain relievers help?

Acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, and reduce fever. NSAIDs can also reduce inflammation (redness and swelling).

OTC pain relievers can be helpful in treating many types of pain, such as pain from arthritis, earaches, back pain, and pain after surgery. They can also treat pain from the flu (influenza) or a cold, sinusitis, strep throat or a sore throat. Children who may have the flu or chickenpox should not take aspirin because they are at higher risk to develop a condition called Reye’s Syndrome.

Acetaminophen can be a good choice for relieving headaches and other common aches and pains. It can be used safely by most people on a long-term basis for arthritis and other chronic painful conditions if pain is improved. Make sure you tell your doctor about any OTC medications you take regularly.

Ibuprofen is helpful for menstrual cramps and pain from inflammation (such as muscle sprains). If ibuprofen doesn’t work for you, naproxen and ketoprofen may be options.

Will an OTC pain reliever work as well as a prescription one?

For most people, OTC drugs are all they need to relieve pain or reduce fever. If an OTC drug doesn’t help your pain or fever, or if you’ve been taking an OTC drug for more than 10 days for pain or 3 days for fever, call your doctor. These may be signs that you have a more serious problem or need a prescription medicine.

What are some common side effects of OTC pain relievers?

Side effects from OTC pain relievers aren’t common for healthy adults who only use pain relievers once in a while. However, side effects can be a concern for people who use pain relievers often or who have health problems. If you have health problems or use pain relievers often, talk to your doctor.

Acetaminophen can be used safely by most people. It can cause liver damage in people who take very high doses or who already have abnormal liver function . To reduce your risk of liver problems, never take more than the recommended dose of acetaminophen. For adults and children older than 12, this means a maximum of 8 extra-strength or 12 regular-strength pills a day.

With long-term use, NSAIDs can cause gastrointestinal (GI) problems. These problems range from upset stomach to ulcers to GI bleeding. For minor stomach upset, eating some food or drinking some milk before you take an NSAID may help. Your risk of GI problems from NSAIDs goes up the higher the dose you take and the longer you take them. Drinking alcohol may increase this risk. Acetaminophen is much less likely than NSAIDs to cause GI problems.

NSAIDs may also make high blood pressure worse. If NSAIDs are used regularly for many years, they can also hurt your kidneys. Your doctor can check for this problem with a blood test.

If you have questions about the side effects of OTC pain relievers, talk to your doctor.

Who shouldn’t take NSAIDs?

You shouldn’t take NSAIDs if you are allergic to aspirin or other pain relievers. Talk to your doctor or before you take an NSAID, especially aspirin, if you:
 
  • Take blood-thinning medicine or have a bleeding disorder
  • Have bleeding in the stomach or intestines, or have peptic (stomach) ulcers
  • Have liver or kidney disease
  • Have 3 or more drinks that contain alcohol every day

Can OTC pain relievers cause problems with any other medicines I take?

If certain drugs are taken at the same time, they can interact with each other and change the way your body processes them. This is called a drug interaction. When this happens, the risk of side effects increases.

For example, if someone who takes high blood pressure medicine also takes an NSAID, the high blood pressure medicine may not work as well as it should.

Many OTC drugs contain the same pain reliever or contain ingredients found in prescription drugs. By combining OTC medicines or taking a prescription drug with an OTC drug, you may be getting more than the recommended dose of the active ingredient (the substance in the medicine that works to relieve your symptoms). For example, many OTC cold medicines contain acetaminophen. If you were to take one of these products and also take acetaminophen separately, you would be taking much more acetaminophen than you intended.

What should I look for on the drug label?
When choosing an OTC pain reliever, check the drug label for possible side effects or interactions with other drugs you are taking. This information will appear in the “Warnings” section of the label.

Be sure to check that you are not taking two medicines that contain the same active ingredient. You will find this information in the “Active Ingredient” section.

Always read and follow the directions on the label. Be sure you understand the label information before taking the medicine. If you have any questions, ask your family doctor or pharmacist.

Recovering from a Hip Fracture

What is a hip fracture?

A hip fracture is a break in the bones of your hip (near the top of your leg). It can happen at any age, although it is more common is people 65 and older. As you get older, the inside of your bones becomes porous from a loss of calcium. This is called losing bone mass. Over time, this weakens the bones and makes them more likely to break. Hip fractures are more common in women, because they have less bone mass to start with and lose bone mass more quickly than men.

How is a hip fracture treated?

Most people who have hip fractures will need surgery to make sure the leg heals properly. Your doctor will discuss your surgery options with you.

Some people are unable to have hip surgery because of an illness or poor health. If your doctor doesn’t think it’s safe for you to have surgery, you will be put into traction to help your hip heal. Traction keeps you immobile for a long period of time.

What are the symptoms of a hip fracture?

Hip fractures usually are caused by a fall. If you fracture your hip, you may experience the following symptoms:
  • Severe pain in your hip or pelvic area
  • Bruising and/or swelling in your hip area
  • Inability to put weight on your hip or difficult walking
  • The injured leg may look short than the other leg and may be turned outward
Any time you fall and are unable to get up or stand, call your doctor right away. He or she may take an X-ray to check for hip fracture.

What can I expect after surgery?

Your doctor can tell you when you should try to stand or walk after surgery. It may be painful to walk at first. You may need a walker or cane for assistance for several months after surgery.

You may need to see a physical therapist as part of your recovery. In physical therapy, you’ll learn to sit, stand and walk without reinjuring your hip. You’ll also do exercises to help you get stronger.

When you return home after your surgery, you may need some help from a home nurse or family member. Daily tasks may be difficult to perform while you aren’t able to move around very well. A family member or nurse can help you with your daily tasks, such as bathing, cooking and shopping.

What about complications?

A hip fracture is a serious injury, but the complications from a hip fracture can be severe or even life-threatening. If you are immobile for a long period of time after your surgery, or if you are in a traction, you are at risk of developing deep vein thrombosis. Deep vein thrombosis (also called DVT) is a blood clot in a vein deep inside your body. These clots usually occur in your leg veins. If the blood clot breaks away and travels through your bloodstream, it could block a blood vessel in your lungs. This blockage (called a pulmonary embolism) can be fatal.

Other complications from immobility after hip surgery can include:
  • Pressure sores
  • Pneumonia
  • Muscle wasting
  • Urinary tract infections
  • Bedsore

How can I prevent another hip fracture?

To help prevent a hip fracture, you should:
  • Get regular physical activity to keep your bones and muscles strong.
  • Don’t drink or smoke.
  • Eat and drink more products with calcium (for example: milk, cottage cheese, yogurt, sardines and broccoli) to keep your bones strong.
  • Take vitamin D each day, which helps your body absorb calcium. Your doctor can tell you how much vitamin D is safe for you.
  • If your doctor suggests that you use a cane or a walker to help you walk, be sure to use it. This will give you extra stability when walking and will help you avoid a bad fall.
  • See your eye doctor once a year. If you can’t see well because of cataracts or other eye diseases, you are more likely to fall.
  • Ask your doctor about medicines that can keep your bones strong and about products that can protect your hips if you fall.
  • Make your house safer. Make sure that you have good lighting in your home, which will help you avoid tripping over objects that are not easy to see. Put night lights in your bedroom, hallways and bathrooms. Rugs should be firmly fastened to the floor or have nonskid backing. Loose ends should be tacked down. Electrical cords should not be lying on the floor in walking areas. Put hand rails in your bathroom for bath, shower and toilet use. Have rails on both sides of your stairs for support. Be sure the stairs are well lit.