Mohamadou Preveiw

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 39 expert in you. By participating in your healthcare, taking your medicines as prescribed, and working with your healthcare team, you can improve or maintain your health. It is okay to ask your healthcare team questions, such as: • Who is providing your care? • What are they doing? • Why are they doing it? HOW YOU CAN WORK WITH YOUR HEALTHCARE TEAM We are living in an age where healthcare professionals’ time is short. So, it is recommended that you make a habit of going to your medical appoint- ments prepared. Here are some ways to do that: • If you are experiencing symptoms, keep a health journal. Write down what your symptoms are, when they are occurring -in the morning, evening, after exercise-and other important information. • Be ready to share your medical history, along with the conditions that you have been diagnosed with, your medication history, and any procedures you’ve had. You should also know what is in your medical record. • If you have questions, write them down before your appointment. • Educate yourself about any condition you have, and learn about your treatment options by discussing your concerns with your healthcare team and loved ones. • Keep track of the medicines you take, when you take them, and what you are taking them for. Be sure to include any over-the- counter or herbal medications you may be taking.

CHAPTER 7 AFTER YOUR APPOINTMENT After you meet with your doctor, you will need to follow his or her instructions to keep your health on track. Your doctor may have you fill a prescription or make another appointment for tests, lab work, or a follow-up visit. It is important for you to follow your doctor’s instructions. It is also important to call your doctor if you are unclear about any instructions or have more questions. Follow the instructions your doc- tor gave you, including filling a prescription, scheduling tests, or making another appointment. Call your doctor if you still have questions or if there is anything you do not understand. Watch closely for changes in your health and be sure to contact your doctor if you have any problems or symptoms that concern you. Follow-up care is a key part of your treatment and safety. Update the medical records that you keep at home, including new test re- sults and medicine changes.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 41 PRIORITIZE YOUR QUESTIONS Create a list of follow-up questions to ask if you: • Have a health problem • Need to get or change a medicine • Need a medical test • Need to have surgery OTHER TIMES TO CALL YOUR DOCTOR There are other times when you should follow up on your care and call your doctor. Call your doctor: • If you experience any side effects or other problems with your medicines. • If your symptoms get worse after seeing the doctor • If you receive any new prescriptions or start taking any other-the- counter medicines. • To get results of any tests you’ve had. • To ask about test results you do not understand. Your questions help your doctor and health care team learn more about you. Your doctor’s answers to your questions can help you make better de- cisions, receive a higher level of care, avoid medical harm, and feel better about your health care. Your questions can also lead to better results for your health. Be sure that you understand and follow the directions given to you by your doctor. This is an important part of your responsibility as a patient. Before you leave the doctor’s office, ask any questions you may have about your medications, tests, referrals, and when to call the doctor. Follow through on your next steps:

42 MOHAMADOU M. DIENE • Schedule your follow-up appointment if required, and any future appointments. • Be sure you have received any referrals if directed by your doctor. • Be sure you have any prescriptions slips. Understand when and how to take the medications. • Know how and when you will receive your test results. • Understand what you can do at home to improve your health. • Discover how to enhance your health or treatment plan through nutrition and fitness. • Read more about any medical conditions you may have. • Be a prepared patient, get involved. Get more involved with your health care by asking questions, talking to your clinician, and understanding your condition. Patients and families who engage with health care providers ask good questions and help reduce the risk of errors and hospital admissions. Be smart about your healthcare appointments. Bring the information your provider will need to the ap- pointment, including your healthcare records if necessary. Address the key issues early in the visit and be prepared to explain the symptoms clearly. Don’t leave until you understand what the provider tells you and what you need to do next. When the appointment is over, make sure that you are satisfied with your visit and the care that you received.

CHAPTER 8 WHAT SHOULD I DO IF I GET A SERIOUS DIAGNOSIS? Sometimes a visit to your healthcare provider turns out to be any- thing but routine. If you are diagnosed with a serious disorder, emo- tions like confusion and fear might make communicating with your physician even tougher. It can feel like a punch in the stomach, or it may take your breath away. If your doctor tells you that you’ve been diagnosed with a serious illness or condition, that news can be devastating. Plans and priorities change in- stantly when you’re facing a major cancer, serious heart disease or other life- threatening condition. Patients can be overwhelmed with anxiety, fear and sadness. However, there are recommended steps patients can take to best nav- igate their suddenly challenging situation. For starters, marshal your energies

44 MOHAMADOU M. DIENE and resources and don’t feel pressured into making hasty decisions, espe- cially about significant, invasive procedures or surgery unless your life is in imminent danger. You likely will have time to digest your diagnosis, be- come informed and seek other expert medical opinions. This is where it is helpful to take a family member or close friend to your medical appointments—not just for moral support but also that you have an advocate who can ask questions, take notes and help clarify, process the barrage of information you will receive, and improve communication be- tween you and your doctor. Some people find it useful to tape-record their meeting with a doctor to discuss diagnosis, options and prognosis. As your situation evolves, you need to become an informed patient, someone who assists with your care by sharing key information about your- self, while also understanding the medical expectations that may benefit you and your care. Your research may take you online. Several hospital websites provide overviews of a large number of illnesses. You also may wish to look at the Mayo Clinic and Johns Hopkins sites. Information also is provided online by the Center for Disease Control and Prevention, the National Institute of Health, and the American Academy of Family Physicians. Almost every disease and condition has its own web- site that offers more in-depth information, including timely information on research and treatments. Most of these sites provide information on support groups that can be valuable. But there’s plenty of erroneous information online, too. You’ll want to avoid not only this misinformation but also con artists, pseudo scientists and outright frauds in cyberspace. Understand that your own moods and sensitivities may run high and low in your difficult situation. But your com- mon sense, for your own protection at this crucial time, can’t be van- quished: if a therapy or medical promise sounds too good to be true, it de- mands verification and skepticism. MedlinePlus, a service of the National Library of Medicine and the National Institute of Health, offers a 16-mi- nute video tutorial on how to evaluate online health information. It is okay to seek other medical views.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 45 Once you are informed, compile a list of questions and consider seeking a second opinion. Surprisingly, most people don’t do either. This is a mis- take. For starters, your diagnosis may be inaccurate. Statistics vary as to how often this occurs. Your case may fall into a gray area in medicine as to its care; some conditions are tricky to diagnose. Even if your original diagnosis is accurate, a second physician may suggest a different course of care or ad- ditional treatment options. And having your diagnosis confirmed enables you to make decisions with greater confidence. Don’t worry that getting a second opinion will offend your physician. Some insurance companies require it before covering treatment. When seek- ing a second opinion, look for a clinician with a different background than yours and who preferably isn’t affiliated with the same hospital or practice. You can get referrals from a trusted physician, friend or your health care provider, or by contacting your local medical association. Look closely to see the medical caregiver’s academic and professional credentials, board cer- tification status, specialty training and affiliations and information you can find on his or her clinical outcomes. You want to seek out the best and the brightest expert with the most experience in treating your particular ailment. Before your appointment, ask your physician to send over all tests and im- aging studies or make a copy of the records for yourself so you don’t have to pay to have them repeated. Your doctors are legally obligated to provide you with these records, although they may charge a fee to make copies. Don’t subject yourself to needless over-testing or excessive examinations. Don’t forget to bring your trusted companion with you and be sure to ask about the risks and benefits of all treatment options, including delaying therapy. Several institutions, including Johns Hopkins, Partners Healthcare and the Cleveland Clinic, offer online consultations to distant patients, espe- cially those seeking highly specialized care. Patients in these situations may send key diagnostic records by fax, mail or the internet for review and ad- visement. If the second doctor disagrees with your original diagnosis, you may consider a third opinion. Be realistic, however, if, on balance, clinicians are offering the same view of your condition and care, it may not be prudent

46 MOHAMADOU M. DIENE to delay therapeutic measures while you seek yet other opinions. DECIDING WHO TO TELL Even as you wrestle with and then decide on your medical course, you’ll face sensitive issues over who you will share information with about your illness and care. Experts agree that parents must be honest with their chil- dren, offering accurate but age-appropriate information. Children are intu- itive. If you don’t tell them what’s going on with you, they may imagine something far worse, blame themselves or worry that they will get sick, too. Children take their cues from you, so try to be calm and reassuring. Keeping their lives as routine as possible will also help them feel secure. When it comes to your employer, only you can decide what’s best. But know your rights. The Americans with Disabilities Act guarantees that you can’t be terminated for illness if you can do your job with reasonable ac- commodation. Under the Family and Medical Leave Act (FMLA), you are entitled to twelve weeks of unpaid leave due to a health condition, without disclosing your specific diagnosis. You are guaranteed an equivalent, though not necessarily the exact position, upon your return. To qualify, you must have worked for a company with fifty or more employees for at least a year, clocking at least 1,250 hours of work. It’s crucial too, that others know your wishes. It’s best to tackle this task when you’re healthy and feeling well. It’s all the more crucial if you’re con- fronting serious illness. Everyone needs to prepare an advance health care directive that describes the limits they want placed on treatments at the end of life. There are other health care planning documents you should con- sider, discuss with your family and medical caregivers and put in place. Ad- vance directives allow the patient to state in advance the kinds of medical care that he or she considers acceptable or not acceptable. Advance direc- tives are written instructions letting others know the type of care you want if you are seriously ill or dying. There are two main kinds: • Living wills—A living will records your end-of-life wishes for

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 47 medical treatment in case you are no longer able to speak for your- self. Living wills typically refer only to life-prolonging treatment when you are close to death. • Healthcare proxies—A healthcare proxy is named through a “du- rable power of attorney for health care.” Sometimes this person may be referred to as a representative, surrogate, agent, or attor- ney-in-fact. A healthcare proxy is helpful if you do not want to be specific about your end-of-life treatment, and you would rather let the healthcare proxy evaluate each situation or treatment option independently. This type of advanced directive is also important if you want your healthcare proxy to be someone who is not a legal member of your family. The patient can appoint an agent to make those decisions on his or her behalf. Patients should be asked at the time of admission to the hospital if they have an advance directive. If the patient does not have an advance di- rective, the organization should provide the patient with information as to what an advance directive is and the opportunity to execute a directive. Every patient should clearly understand that an advance directive is a guide- line for caregivers as to his or her wishes for what medical care he or she would or would not want to receive in the event he or she becomes inca- pacitated and unable to make decisions. This interaction should be docu- mented in the patient’s medical record. If the patient has an advance di- rective, a copy should be requested for insertion in the patient’s record. If the patient does not have a copy of the advance directive with him or her, the substance thereof should be documented and flagged in the pa- tient’s medical record. Documentation should include the location of the advance directive, the name and telephone number of the designated health care agent, and any information that might be helpful in the immediate care situation. The purpose of such documentation should not be considered as a desire to recreate a new directive but should be considered as a desire to adhere to a patient’s wishes in the event some untoward event occurs while

48 MOHAMADOU M. DIENE waiting for a copy of the directive. The patient can execute a new directive at any time if desired. Patient and family education should be provided as to the existence of the directives and of its contents. The patient should be periodically queried as to whether he or she wishes to make any changes with regard to an advance directive. DO NOT RESUSCITATE ORDERS OR DNR The DNR request is usually made by the patients or health care power of attorney and allows the medical team taking care of them to respect their wishes. Do Not Resuscitate orders indicate that in the event of a cardiac or respiratory arrest, no resuscitative measures should be used to revive the pa- tient. A DNR order is an extremely difficult decision to make for both the patient and family. It is generally made when one’s quality of life has been so diminished that “heroic” rescue methods are no longer in the patient’s best interest. DNR orders must be in writing, signed, and dated by the phy- sician. Appropriate consent must be obtained from the patient or his or her health care agent. DNR orders must comply with statutory requirements, be of short duration and be revisited periodically to determine whether the patient’s condition or other circumstances—change of mind by the patient or family—surrounding the “no code” orders have changed. No code” is a reference to the use of “code” as jargon for “calling in a Code Blue” to alert a hospital’s resuscitation team. At present, it is generally accepted that if a patient is competent, the DNR order is considered to be the same as other medical decisions in which a patient may choose to reject life-sustaining treatment. In the case of an incompetent patient or the absence of any writ- ten advance directive, the best interest of the patient would be considered. Helpful websites: Advance directive www.mindspring.com Coping with a serious diagnosis is a major challenge. But know that you

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 49 aren’t alone. If you need inspiration and feel as if your own struggles mean more if they contribute to the collective good, know that informed patients can advance medical science by participating in clinical trials, which also may offer them experimental therapies that eventually may become a new standard of care. Finally, countless Americans triumph over significant health issues every year. With continued medical advances, the prognosis for so many has never been better.

CHAPTER 9 TALKING TO DOCTORS IN SPECIAL SITUATIONS REQUESTING A REFERRAL Many health plans do require a referral from a primary care provider for specialty care. Follow the steps below when requesting a referral. 1. VISIT YOUR PRIMARY CARE PHYSICIAN Your primary care physician will evaluate your concern and, if necessary, make a referral to a specialist. If your health plan requires you to see someone

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 51 from a list of preferred specialists, please bring that information with you to your appointment. 2. VERIFY YOUR INSURANCE AND REFERRAL INFORMATION Contact your insurance company for referral requirements. Check that the physician you have been referred to is a preferred provider and that your visit will be covered. Provide your doctor’s office with the proper insurance information so they can promptly send your referral request to the correct plan. Members of a health maintenance organization (HMO) pay a set monthly fee no matter how many times they see a doctor. Usually there are no deductibles or claims forms, but you will have a co-payment for doctor visits and prescriptions. Each member chooses a primary care doctor from within the HMO network. The primary care doctor coordinates all care and, if necessary, refers members to specialists. A preferred provider organ- ization (PPO) is a network of doctors and other healthcare providers. The doctors in this network agree to provide services to PPO health plan mem- bers at discounted costs. Members can choose to see any doctor at any time. Choosing a non-PPO provider is called “going out of network” and will cost more than seeing a member of the PPO network. 3. MAKE AN APPOINTMENT WITH THE SPECIALIST Once your health plan has approved the referral, you may call and make your appointment with the specialist. In some cases, the referring doctor may book the first appointment for you. Please verify that any pertinent medical records have been sent to the specialist prior to your appointment because your specialist may not receive basic medical information from your primary care doctor. Or sometimes your primary care doctor does not re- ceive a report back from a specialist, test results/medical records were not available at the time of appointment Doctors are very busy, and sometimes, failed to provide important medical

52 MOHAMADOU M. DIENE information to other doctors or nurses you think should have it. No one contacted you about test results, or you had to call repeatedly to get results? These problems exist mainly due to the current fragmentation of care. Fragmentation of health care and lack of coordination of services are widely recognized as problems. Considerable efforts now aim to improve communication among providers when a person leaves the hospital, for ex- ample, and great stock is placed in the potential of the new patient-centered medical home to coordinate care. Care coordination is the deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate appropriate delivery of health care services. In this definition, providers working with a particular patient share important clinical information and have clear, shared expectations about their roles. Equally important, they work together to keep patients and their families informed to ensure that effective referrals and transitions take place. Reducing care fragmentation by providing coordinated care is an essential feature of any patient centered care, and one that can be challenging to implement. Patient-centered care is care that is responsive to patient and family needs and preferences. Pa- tient-centered care supports active involvement of patients and their fami- lies in the design of new care models and in decision-making about individ- ual options for treatment. The Institute of Medicine defines patient-cen- tered care as: “Providing care that is respectful of and responsive to individ- ual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” Patient-centered care is also one of the over- reaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design. Care that is truly patient-centered cannot be achieved without active patient engage- ment at every level of care design and implementation. The medical home is a patient-centered philosophy that drives primary care excellence. The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It is not a final destination instead, the medical

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 53 home is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in a manner that best suits a pa- tient’s needs. A visit to the specialist may be short. Often, the specialist already has seen your medical records or test results and is familiar with your case. If you are unclear about what the specialist tells you, ask questions. For example, if the specialist says you have a medical condition that you aren’t familiar with, you may want to say something like: “I don’t know very much about that condition. Could you explain what it is and how it might affect me?” or “I’ve heard that is a painful problem. What can be done to prevent or manage the pain?” You also may ask for written materials to read, or you can call your pri- mary doctor to clarify anything you haven’t understood. Ask the specialist to send information about any further diagnosis or treatment to your primary doctor. This allows your primary doctor to keep track of your medical care. You also should let your primary doctor know at your next visit how well any treatments or medications the specialist recommended are working. Questions to ask your specialist: • What is my diagnosis? • What treatment do you recommend? How soon do I need to begin the new treatment? • Will you discuss my care with my primary doctor? IF YOU NEED SURGERY If your doctor recommends surgery as treatment, ask questions to be better informed and prepared. Also, don’t hesitate to get a second opinion about whether surgery is right for you. In some cases, surgery may be the best treatment for your condition. If so, your doctor will refer you to a surgeon. Knowing more about the operation will help you make an informed decision

54 MOHAMADOU M. DIENE about how to proceed. It also will help you get ready for the surgery, which makes for a better recovery. Ask the surgeon to explain what will be done during the operation and what reading material, videos, or websites you can look at before the operation. Find out if you will have to stay overnight in the hospital or if the surgery can be done on an outpatient basis. Will you need someone to drive you home? Minor surgeries that don’t require an overnight stay can sometimes be done at medical centers called ambulatory surgical centers. Questions to ask your surgeon: • What is the success rate of the operation? How many of these op- erations have you done successfully? • What problems occur with this surgery? What kind of pain or dis- comfort can I expect? • What kind of anesthesia will I have? Are there any risks associated with it for older people? • Will I have to stay in the hospital overnight? How long is recovery expected to take? What does it involve? When can I get back to my normal routine? SEEKING A SECOND OPINION When surgery is recommended, patients often seek a second opinion. Hear- ing the views of two different doctors can help you decide what’s best for you. In fact, your insurance plan may require it. Doctors are used to this practice, and most will not be insulted by your request for a second opinion. Your doctor may even be able to suggest other doctors who can review your case. Always remember to check with your insurance provider in advance to find out if a second opinion is covered under your policy, if there are restrictions to which doctors you can see, and if you need a referral form from your primary doctor.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 55 IF YOU ARE HOSPITALIZED If you have to go to the hospital, some extra guidelines may help you. First, most hospitals have a daily schedule. Knowing the hospital routine can make your stay more comfortable. Find out how much choice you have about your daily routine and express any preferences you have about your schedule. Doctors generally visit patients during specific times each day. Find out when the doctor is likely to visit so you can have your questions ready. In the hospital, your primary doctor and various medical specialists, as well as nurses and other health professionals may examine you. If you are in a teaching hospital, doctors-in-training known as medical students, interns, residents, or fellows also may examine you. Many of these doctors-in-train- ing already have a lot of knowledge and experience. They may be able to take more time to talk with you than other staff. Nurses also can be an important source of information, especially since you will see them often. Questions to ask medical staff in the hospital: • How long can I expect to be in the hospital? • When will I see my doctor? What doctors and health professionals will I see? • What is the daily routine in this part of the hospital? It is your right to be told about the condition of your health, including description of your illness and types of treatment available, their expected results and possible risks, benefits, alternatives and costs, and to be part of your healthcare decisions.

CHAPTER 10 PATIENT BILL OF RIGHTS The patient must be informed by the organization or facility provid- ing care to him or her of his or her rights and responsibilities. The rights of patients must be respected all times. Each patient is an individual with unique health care needs. The patient has a right to make decisions regarding his or her medical care, including the decision to dis- continue treatment to the extent permitted by law. Patients have a right to: 1. Receive an explanation of their rights. 2. Receive assistance in understanding their rights, including an in- terpreter. 3. Receive treatment without discrimination as to race, color, reli- gion, gender, national origin, disability, sexual orientation, or

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 57 source of payment. 4. Receive considerate and respectful care in a clean and safe environ- ment free of unnecessary restraints. 5. Receive emergency care if needed. 6. Be informed of the names and positions of the caregivers who will be in charge of their care in the hospital or the medical office. 7. Know the names, positions, and functions of any hospital staff in- volved in their care, and refuse treatment, examination, or obser- vation by them. 8. Receive complete information about their diagnoses, treatment, and prognosis. 9. Receive all the information they need to give informed consent for any proposed procedure or treatment. This information shall in- clude the possible risks and benefits of the procedure or treatment. 10. Receive all the information they need to give informed consent for an order not to resuscitate. They also have the right to designate an individual to give consent if they are too ill to do so. 11. Refuse treatment and be told what effect this may have on their health. 12. Refuse to consent or decline to participate in research. 13. Expect privacy while in the hospital and confidentiality of all in- formation and records regarding their care. 14. Participate in all decisions about their treatment and discharge from the hospital. 15. Review and obtain a copy of their medical records. 16. Receive an itemized bill and explanation of all charges. 17. Complain without fear of reprisal about the care and services they are receiving. 18. Know the hospital’s relationships with outside parties that may influ- ence a patient’s treatment, and care. These relationships may be with educational institutions, insurers, and other health care providers. 19. Know about hospital resources, such as patient representations or

58 MOHAMADOU M. DIENE ethics committees, that can help resolve problems and questions about the hospital stay and care. PATIENT RESPONSIBILITIES Patients have responsibilities as well as rights. Patient responsibilities in- clude: • Fully disclosing all information relevant to one’s medical condition. • Providing accurate, timely, and complete information regarding complaints, past illnesses, hospitalizations, and medications. • Reporting unexpected changes in condition to the treating practitioner. • Making it known whether one clearly understands the contemplated plan of care, course of treatment, and what is expected from oneself. • Following the treatment plan recommended by the practitioner (this may include the instructions of nurses, and allied health personnel). • Following the organization’s rules and regulations. • Refraining from self-administration of medications not prescribed by the attending physician. • Keeping appointments and, when unable to do so, notifying the responsible practitioner or health care facility. • Accepting the consequences of refusing treatment or not following instructions. • Being considerate of the rights of others, including health care personnel in assisting in the control of noise, smoking, and the number of visitors. • Being respectful of the property of other persons and of the health care facility.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 59 • Recognizing the effect of lifestyle as it affects one’s personal health. PATIENT ADVOCACY Because patients are often helpless and unable to speak for themselves, all caregivers should consider themselves as patient advocates. Patient advocacy can be accomplished by caregivers providing care in their particular areas of responsibility and expertise. Many states have established, by legislation, ombudsperson program which was first initiated in Sweden. Ombudper- sons are responsible for the investigation of reports of residence abuse in nursing homes facilities. IF YOU GO TO THE EMERGENCY ROOM A visit to the emergency room can be stressful. It may go more smoothly if you can take along the following items: • Your health insurance card or policy number. • A list of your medications. • A list of your medical problems. • The names and phone numbers of your doctor and one or two family members or close friends. Some people find it helpful to keep this information on a card in their wallet or purse at all times. Depending on the problem, you may have a long wait in the emergency room. Consider taking things to make the wait more comfortable, such as something to read and a sweater in case the room is too cold. While in the emergency room, ask questions if you don’t un- derstand tests or procedures that are being done. Before leaving, make sure you understand what the doctor told you or ask for written instructions.

60 MOHAMADOU M. DIENE For example, if you have bandages that need changing, be sure you under- stand how and when it should be done. Tell your primary doctor as soon as possible about your visit to the emergency room. Questions to ask medical staff in the emergency room: • Will you talk to my primary doctor about my care? • Do I need to arrange any further care? • Can I get instructions for further care in writing? • Is there someone here who speaks my language and can explain the instructions? FIND OUT ABOUT DIFFERENT TREATMENTS You will benefit most from a treatment when you know what is happening and are involved in making decisions. Make sure you understand what your treatment involves and what it will or will not do. Have the doctor give you directions in writing and feel free to ask questions. For example: “What are the pros and cons of having surgery at this stage?” or “Do I have any other choices?” If your doctor suggests a treatment that makes you uncomfortable, ask if there are other treatments that might work. If cost is a concern, ask the doctor if less expensive choices are available. The doctor can work with you to develop a treatment plan that meets your needs. Here are some things to remember when deciding on a treatment: • Discuss choices. There are different ways to manage many health conditions, especially chronic conditions like high blood pressure and cholesterol. Ask what your options are. • Discuss risks and benefits. Once you know your options, ask

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 61 about the pros and cons of each one. Find out what side effects might occur, how long the treatment would continue, and how likely it is that the treatment will work for you. • Consider your own values and circumstances. When thinking about the pros and cons of a treatment, don’t forget to consider its impact on your overall life. For instance, will one of the side ef- fects interfere with a regular activity that means a lot to you? Is one treatment choice expensive and not covered by your insur- ance? Doctors need to know about these practical matters and can work with you to develop a treatment plan that meets your needs. Questions to ask about treatment: • Are there any risks associated with the treatment? • How soon should treatment start? How long will it last? • Are there other treatments available? • How much will the treatment cost? Will my insurance cover it? DISCUSSING SENSITIVE SUBJECTS Don’t hesitate to talk about sensitive topics with your doctor. Addressing these concerns are an important part of your health care. Much of the com- munication between doctor and patient is personal. To have a good part- nership with your doctor, it is important to talk about sensitive subjects, like sex or memory problems, even if you are embarrassed or uncomfortable. Most doctors are used to talking about personal matters and will try to ease your discomfort. Keep in mind that these topics concern many older people. It is important to understand that problems with memory, depression, sexual function, and incontinence are not necessarily normal parts of aging. A good doctor will take your concerns about these topics seriously and not

62 MOHAMADOU M. DIENE brush them off as being normal. If you think your doctor isn’t taking your concerns seriously, talk to him or her about your feelings or consider look- ing for a new doctor. Alcohol Anyone at any age can have a drinking problem. Alcohol can have a greater effect as a person grows older because the aging process affects how the body handles alcohol. Someone whose drinking habits haven’t changed may find over time that he or she has a problem. People can also develop a drinking problem later in life due to major life changes like the death of loved ones. In fact, depression in older adults often goes along with alcohol misuse. Talk to your doctor if you think you may be developing a drinking problem. You could say: “Lately I’ve been wanting to have a drink earlier and earlier in the afternoon, and I find it’s getting harder to stop after just one or two. What kind of treatments could help with this?” Falling and fear of falling A fall can be a serious event, often leading to injury and loss of independ- ence, at least for a while. For this reason, many older people develop a fear of falling. Studies show that fear of falling can keep people from going about their normal activities, and as a result, they may become frailer, which ac- tually increases their risk of falling again. If fear of falling is affecting your day-to-day life, let your doctor know. He or she may be able to recommend some things to do to reduce your chances of falling. Exercises can help you improve your balance and strengthen your muscles at any age. Feeling unhappy with your doctor Misunderstandings can come up in any relationship, including between a patient and his or her doctor or the doctor’s staff. If you feel uncomfortable with something your doctor or his or her staff has said or done, be direct. For example, if the doctor does not return your telephone calls, you may want to say something like this: “I realize that you care for a lot of patients

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 63 and are very busy, but I feel frustrated when I have to wait for days for you to return my call. Is there a way we can work together to improve this?” Being honest is much better for your health than avoiding the doctor. If you have a long-standing relationship with your doctor, working out the problem may be more useful than looking for a new doctor. Grief, mourning, and depression As people grow older, they may lose significant people in their lives, includ- ing spouses and cherished friends. Or, they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make sug- gestions that may be helpful to you. Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also tell your doctor about symp- toms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression which is a medical condition. Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered normal at any age. Let your doctor know about your feelings and ask about treatment. HIV/AIDS The death of a spouse, a divorce, or a separation can lead some older people to find themselves dating again and possibly having sex with a new partner. It’s a good idea to talk to your doctor about how safe sex can reduce your risk of sexually transmitted diseases such as HIV/AIDS. It’s important to practice safe sex, no matter what your age. Incontinence Older people sometimes have problems controlling their bladder. This is called urinary incontinence and it can often be treated. Depending on the type of incontinence you have, the doctor may recommend exercises, suggest

64 MOHAMADOU M. DIENE helpful ways to change your habits, prescribe useful medications, or advise surgery. If you have trouble controlling your bladder or bowels, it is im- portant to let the doctor know. To bring up the topic, you could say some- thing like: “Since my last visit there have been several times that I couldn’t control my bladder.” Memory Problems Many older people worry about their ability to think and remember. For most older adults, thinking and memory remain relatively intact in later years. However, if you or your family notice that you are having problems remembering recent events or thinking clearly, let your doctor know. Be specific about the changes you’ve noticed. For example, you could say: “I’ve always been able to balance my checkbook without any problems, but lately I’m very confused.” Your doctor will probably want you to have a thorough checkup to see what might be causing your symptoms. In many cases, memory problems are caused by conditions such as de- pression, or they may be a side effect of medication. Sometimes, the prob- lem is a type of dementia, such as Alzheimer’s disease. With a careful family history, physical exam, medical tests, and tests of memory and problem solving, specialists can diagnose Alzheimer’s with a high degree of accuracy. Determining the cause of memory problems is important to help the doc- tor, patient, and family choose the best plan of care. Although there is no cure for Alzheimer’s, medicines can help for a while, especially in the early stages of the disease. Treatments (medication and non-medication) can also ease serious behavioral symptoms such as agitation, anxiety, and depression. Support groups and education are important and can help patients and caregivers. If you are worried about memory problems and Alzheimer’s disease, you can contact the Alzheimer’s Disease Education and Referral (ADEAR) Cen- ter, a service of the National Institute on Aging. ADEAR staff can: • Answer specific questions about Alzheimer’s.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 65 • Send free publications. • Refer callers to local resources. • Provide information about clinical trials. • Help you find materials about specific issues. Call toll-free 1-800-438-4380 or visit the ADEAR website. Problems with family Even strong and loving families can have problems, especially under the stress of illness. Although family problems can be painful to discuss, talking about them can help your doctor help you. Your doctor may be able to suggest steps to improve the situation for you and other family members. If you feel that a family member or caregiver is taking advantage of you or mistreating you, let your doctor know. Some older people are subjected to abuse by family members or others. Abuse can be physical, verbal, psy- chological, or even financial in nature. Your doctor may be able to provide resources or referrals to other services that can help if you are being mis- treated. Sexuality Most health professionals now understand that sexuality remains important in later life. If you are not satisfied with your sex life, don’t just assume it’s due to your age. In addition to talking about age-related changes, you can ask your doctor about the effects of an illness or a disability on sexual func- tion. Also, ask your doctor about the influence medications or surgery may have on your sex life. If you aren’t sure how to bring the topic up, try saying: “I have a personal question I would like to ask you…” or “I understand that this condition or medication can affect my body in many ways. Will it affect my sex life at all?”

CHAPTER 11 WHAT CAN I SAY? GIVING INFORMATION Talking about your health means sharing information about how you feel physically, emotionally, and mentally. Knowing how to describe your symptoms and bring up other concerns will help you become a partner in your health care. SHARE ANY SYMPTOMS Help your doctor better understand what’s going on with your health by telling him or her about any symptoms you’re feeling, medications you take, your daily habits, and other concerns. A symptom is evidence of a disease or disorder in the body. Examples of symptoms include pain, fever, a lump or bump, unexplained weight loss or gain, or having a hard time sleeping.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 67 Be clear and concise when describing your symptoms. Your description helps the doctor identify the problem. A physical exam and medical tests provide valuable information, but your symptoms point the doctor in the right direction. Your doctor will ask when your symptoms started, what time of the day they happen, how long they last—seconds, days— how often they occur, if they seem to be getting worse or better, and if they keep you from going out or doing your usual activities. Take the time to make some notes about your symptoms before you call or visit the doctor. Worrying about your symptoms is not a sign of weak- ness. Being honest about what you are experiencing doesn’t mean that you are complaining. The doctor needs to know how you feel. QUESTIONS TO ASK YOURSELF ABOUT YOUR SYMPTOMS: • What exactly are my symptoms? • Are the symptoms constant? If not, when do I experience them? • Does anything I do make the symptoms better? Or worse? • Do the symptoms affect my daily activities? Which ones? How? Give information about your medications It is possible for medicines to interact causing unpleasant and sometimes dangerous side effects. Your doctor needs to know about all of the medi- cines you take, including over-the-counter (nonprescription) drugs and herbal remedies or supplements. Make a list or bring everything with you to your visit—don’t forget about eye drops, vitamins, and laxatives. Tell the doctor how often you take each. Describe any drug allergies or reactions you have had. Say which medications work best for you. Be sure your doctor has the phone number of the pharmacy you use.

68 MOHAMADOU M. DIENE Tell the doctor about your habits To provide the best care, your doctor must understand you as a person and know what your life is like. The doctor may ask about where you live, what you eat, how you sleep, what you do each day, what activities you enjoy, what your sex life is like, and if you smoke or drink. Be open and honest with your doctor. It will help him or her to understand your medical con- dition fully and recommend the best treatment choices for you. Voice other concerns Your doctor may ask you how your life is going. This isn’t being impolite or nosy. Information about what’s happening in your life may be useful medically. Let the doctor know about any major changes or stresses in your life, such as a divorce or the death of a loved one. You don’t have to go into detail; you may want to say something like: “It might be helpful for you to know that my sister passed away since my last visit with you,” or “I recently had to sell my home and move in with my daughter.” LEARN ABOUT PREVENTION The old saying an ounce of prevention is worth a pound of cure is true. There are steps you can take to help prevent disease and promote good health such as exercising more, maintaining a healthy diet, and getting reg- ular check-ups. Regular check-ups are important Schedule an appointment with your health care provider to discuss what screenings and exams you need and when you need them. Why are Check-Ups Important? Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that help your chances for living a longer,

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 69 healthier life. Your age, health and family history, lifestyle choices (i.e. what you eat, how active you are, whether you smoke), and other important fac- tors impact what type of healthcare services you need and how often you need them. WHERE CAN I GO FOR HEALTH SERVICES? The best place to go for health services is your regular health care provider. However, if you do not have health insurance coverage, following are other options. Job loss is on the rise and many people who cannot afford medical insur- ance on their own, yet don’t qualify for state or federal assistance, will skip medical treatment to save money. Your health is certainly not something you can take lightly. It is your best asset, because when you are in good health, you can take care of other things, like taking care of your loved ones, going to work, getting an education, and taking care of your financial and other assets. Here are 5 places you can check out when you need medical help but don’t have the insurance to cover it: Your Family Doctor Many individuals do not realize it but you can still see your family physician without insurance and be able to afford it. It may take some initiative but approach your doctor about a reduction in rates for services because you are willing to pay cash. Many doctors are happy to work with you because they will likely get more money and get it in a faster time period than when having to deal with insurance or Medicare. Health Care Centers These are not the “free clinics” you might have in your community but there are health care centers regulated and sponsored by the federal govern- ment. These centers provide primary, preventative and dental services to

70 MOHAMADOU M. DIENE people of all ages, based on a sliding payment scale. This means you pay for services based on how much income you make. Check the link findahealthcenter.hrsa.gov to find a center in your area. Planned Parenthood Because Planned Parenthood centers often receive state funding and public donations, the fees for services may be even lower than normal, but you will typically be charged what you can afford, based on your income. Women can receive family planning services, plus other treatment and testing for STD’s, pap tests, breast exams, and birth control for little or no cost. Be sure to call first to discuss your finances if you do not have health insurance. You’ll be able to get a ballpark figure for how much it will cost prior to going to your appointment. Convenience Clinics These are the walk-in health centers located in major retail shopping chains such as pharmacies and Walmart. Typically, these clinics are staffed by RN practitioners and physician’s assistants who can treat and prescribe medica- tions for general colds, flu, and infections. They can also help treat and do preventative check-ups for conditions such as diabetes and high blood pres- sure. The costs will vary from clinic to clinic and depends on your illness or treatment plan. Some places will offer “a la carte” services and some will charge a “flat-rate fee” for services rendered. Free Screenings Many community groups, civic organizations, and local hospitals will offer regular free clinics for specific screenings of diseases such as cancer, diabetes, heart problems, high blood pressure, and other conditions. Check in your local newspaper or group newsletter to see what is coming up in your area and take advantage of the free -or at least discounted- health services. Early detection of many diseases can certainly save your life.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 71 ENCOURAGING OTHERS You may also want to start a campaign in your community (i.e. a faith- based setting, workplace, school, or civic group) to encourage others to make an appointment for a check-up or health screening on National Women’s Check-Up Day (the day after Mother’s Day each year) or Na- tional Men’s Health Week (the week before Father’s Day each year). Self-efficacy is the extent or strength of one’s belief in one’s own ability to complete tasks and reach goals. Psychologists have studied self-efficacy from several perspectives, noting various paths in the development of self- efficacy, the dynamics of self-efficacy, and lack thereof, in many different settings, interactions between self-efficacy and self-concept, and habits of attribution that contribute to or detract from self-efficacy. This can be seen as the ability to persist and a person’s ability to succeed with a task. As an example, self-efficacy directly relates to how long someone will stick to a workout regimen or a diet. High and low self-efficacy deter- mine whether or not someone will choose to take on a challenging task or “write it off” as impossible. Self-efficacy affects every area of human endeavor. By determining the be- liefs a person holds regarding his or her power to affect situations, it strongly influences both the power a person actually has to face challenges compe- tently and the choices a person is most likely to make. These effects are par- ticularly apparent and compelling with regard to behaviors affecting health. Some argued the concepts of locus of control, neuroticism, generalized self-efficacy and self-esteem measured the same, single factor and demon- strated them to be related concepts. When you are dealing with a challenge in your life, do you feel that you have control over the outcome? Or do you believe that you are simply at the hands of outside forces? If you believe that you have control over what happens, then you have what psychologists refer to as an internal locus of control. If you believe that you have no control over what happens and that external variables are to blame, then you have what is known as an external locus of control.

72 MOHAMADOU M. DIENE A locus of control orientation is a belief about whether the outcomes of our actions are contingent on what we do (internal control orientation) or on events outside our personal control (external control orientation). In 1954, psychologist Julian Rotter suggested that our behavior was con- trolled by rewards and punishments, and that it was these consequences for our actions that determined our beliefs about the underlying causes for these actions. Our beliefs about what causes our actions then influence our be- haviors and attitudes. In 1966, Rotter published a scale designed to measure and assess external and internal locus of control. The scale utilizes a forced-choice between two alternatives, requiring re- spondents to choose just one of two possibilities for each item. While the scale has been widely used, it has also been the subject of considerable crit- icism from those who believe that locus of control cannot be fully under- stood or measured by such a simplistic scale. Those with an internal locus of control: • Are more likely to take responsibility for their actions • Tend to be less influenced by the opinions of other people • Often do better at tasks when they are allowed to work at their own pace • Usually have a strong sense of self-efficacy • Tend to work hard to achieve the things they want • Feel confident in the face of challenges • Tend to be physically healthier • Report being happier and more independent • Often achieve greater success in the workplace Those with an external locus of control:

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 73 • Blame outside forces for their circumstances • Often credit luck or chance for any successes • Don’t believe that they can change their situation through their own efforts • Frequently feel hopeless or powerless in the face of difficult situations • Are more prone to experiencing learned helplessness Research has suggested that men tend to have a higher internal locus of control than women and that locus of control tends to become more inter- nal as people grow older. Experts have found that, in general, people with an internal locus of control tend to be better off. However, it is also important to remember that internal does not always equal “good” and external does not always equal “bad.” In some situations an external locus of control can actually be a good thing, particularly if a person’s level of competence in a particular area is not very strong. For example, a person who is terrible at sports might feel depressed or anxious about their performance if they have a strong internal locus of con- trol. If the person thinks, “I’m bad at sports and I don’t try hard enough,” they might feel stressed out in situations where they need to participate in athletics, such as during a physical education class. If this person takes an external focus during such activities (“The game is too hard!” or “The sun was in my eyes!”), they will probably feel more relaxed and less stressed. Doctors and other health professionals may suggest you change your diet, activity level, or other aspects of your life to help you deal with medical conditions. Research has shown that these changes, particularly an increase in exercise, have positive effects on overall health. We now know that it’s never too late to stop smoking, improve your diet, or start exercising. Get- ting regular checkups and seeing other health professionals such as dentists and eye specialists helps promote good health. Even people who have chronic diseases, like arthritis or diabetes, can prevent further disability and, in some cases, control the progress of the disease.

74 MOHAMADOU M. DIENE If a certain disease or health condition runs in your family, ask your doc- tor if there are steps you can take to help prevent it. If you have a chronic condition, ask how you can manage it and if there are things you can do to prevent it from getting worse. If you want to discuss health and disease pre- vention with your doctor, say so when you make your next appointment. This will let the doctor plan to spend more time with you. It is just as important to talk with your doctor about lifestyle changes as it is to talk about treatment. For example: “I know that you’ve told me to eat more dairy products, but they really disagree with me. Is there something else I could eat instead?” or “Maybe an exercise class would help, but I have no way to get to the senior center. Is there something else you could suggest?” As with treatments, consider all the alternatives, look at pros and cons, and remember to take into account your own point of view. Tell your doc- tor if you feel his or her suggestions won’t work for you and explain why. Keep talking with your doctor to come up with a plan that works. TALKING ABOUT EXERCISE Exercise can: • Help you have more energy to do the things you want to do. • Help maintain and improve your physical strength and fitness. • Help improve mood and relieve depression. • Help manage and prevent diseases like heart disease, diabetes, os- teoporosis, and disabilities as people grow older. • Help improve your balance. Many doctors now recommend that people try to make physical activity a part of everyday life. When you are making your list of things to talk about with your doctor, add exercise. Ask how exercise would benefit you, if there are any activities you should avoid, and whether your doctor can recommend any specific kinds of exercise. Start exercising with NIA’s exercise and physical activity campaign,

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 75 Go4Life®, developed specifically for older people. See how to stick with a safe, effective program of endurance, stretching, balance, and strength- training exercises. Visit www.nia.nih.gov/Go4Life or call 1-800-222-2225 (toll-free) for information about the health benefits of exercise and physical activity along with activities you can do to stay fit. Questions to ask about prevention: • Is there any way to prevent a condition that runs in my family before it affects me? • Are there ways to keep my condition from getting worse? • How will making a change in my habits help me? • Are there any risks in making this change? • Are there support groups or community services that might help me?

CHAPTER 12 MEN: STAY HEALTHY AT ANY AGE Use the information below to help you stay healthy. Learn about which screening tests to get, whether you need medicines to pre- vent diseases, and steps you can take for good health. GET THE SCREENING YOU NEED Screenings are tests that look for diseases before you have symptoms. Blood pressure checks and tests for high cholesterol are examples of screenings. You can get some screenings, such as blood pressure readings, in your doctor’s office. Others, such as colonoscopy, a test for colon cancer, need special equipment, so you may need to go to a different office. After a screening test, ask when you will see the results and who you should talk to about them.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 77 Abdominal Aortic Aneurysm If you are between the ages of 65 and 75 and have ever been a smoker, get screened once for abdominal aortic aneurysm (AAA). AAA is a bulging in your abdominal aorta, your largest artery. AAA may burst, which can cause dangerous bleeding and death. An ultrasound, a painless procedure in which you lie on a table while a technician slides a medical device over your abdomen, will show whether an aneurysm is present. Colon cancer Have a screening test for colorectal cancer starting at age 50. If you have a family history of colorectal cancer, you may need to be screened earlier. Several tests can detect this cancer. Your doctor can help you decide which is best for you. Depression Your emotional health is as important as your physical health. Talk to your doctor or nurse about being screened for depression, especially if during the last two weeks: • You have felt down, sad, or hopeless. • You have felt little interest or pleasure in doing things. Diabetes Get screened for diabetes (high blood sugar) especially if you have high blood pressure or if you take medication for high blood pressure. Diabetes can cause problems with your heart, brain, eyes, feet, kidneys, nerves, and other body parts. Hepatitis C virus (HCV) Get screened one time for HCV infection if:

78 MOHAMADOU M. DIENE • You were born between 1945 and 1985 • You have ever injected drugs • You received blood transfusion before 1992. If you currently are an injection drug user, you should be screened regularly. High Blood Cholesterol If you are 35 or older, have your blood cholesterol checked regularly with a blood test. High cholesterol increases your chance of heart disease, stroke, and poor circulation. Talk to your doctor or nurse about having your cho- lesterol checked at age 20 if: • You use tobacco • You are overweight or obese • You have diabetes or high blood pressure • You have a history of heart disease or blocked arteries • A man in your family had a heart attack before age 50 or a woman before age 60. High Blood Pressure Have your blood pressure checked regularly. High blood pressure can cause strokes, heart attacks, kidney and eye problems. Remember, it’s the silent killer. HIV If you are 65 or younger, get screened for HIV. If you are older than 65, ask your doctor or nurse whether you should be screened. Lung cancer Talk to your doctor or nurse about getting screened for lung cancer if you are between the ages of 55 and 80, have a 30 pack-year smoking history,

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 79 and smoke now or have quit within the past 15 years. (Your pack-year his- tory is the number of packs of cigarettes smoked per day times the number of years you have smoked.) Know that quitting is the best thing you can do for your health. Overweight and Obesity The best way to learn if you are overweight or obese is to find your body mass index (BMI). You can find your BMI by entering your height and weight into a BMI calculator, such as the one available at: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. A BMI between 18.5 and 25 indicates a normal weight. Individuals with a BMI of 30 or higher may be obese. If you are obese, talk to your doctor or nurse about getting intensive counseling and help changing your behav- iors to lose weight. Obesity can lead to diabetes and cardiovascular disease. GET PREVENTIVE MEDICINES IF YOU NEED THEM. Aspirin. If you are 45 or older, your doctor or nurse can help you decide whether taking aspirin to prevent a heart attack is right for you. Vitamin D to avoid falls. If you are 65 or older and have a history of falls, mobility problems, or other risks of falling, ask your doctor about taking vitamin D supplement to help reduce your chances of falling. Exercise and physical therapy may also help. IMMUNIZATIONS • Get a flu shot every year • If you are 60 or older, get a shot to prevent shingles. • If you are 65 or older, get a pneumonia shot. • Get a shot for tetanus, diphtheria, and whooping cough. Get a tet- anus booster if it has been more than 10 years since your last shot.

80 MOHAMADOU M. DIENE • Talk with your health care team about whether you need other vaccinations. You can also find which ones you need by going to: http://www.cdc.gov/vaccines. You may not realize that you need vaccines throughout your adult life. Vaccines are still important to your health and here are just three reasons why. 1. You may be at risk for serious diseases that are still common in the U.S. Each year thousands of adults in the United States get sick from diseases that could be prevented by vaccines — some people are hospitalized, and some even die. Even if you got all your vaccines as a child, the protection from some vaccines can wear off over time. You may also be at risk for other diseases due to your age, job, lifestyle, travel, or health conditions. 2. You can’t afford to risk getting sick. Even healthy people can get sick enough to miss work or school. If you’re sick, you may not be able to take care of your family or other responsibilities. 3. You can protect your health and the health of those around you by getting the recommended vaccines. Vaccines lower your chance of getting sick. Vaccines work with your body’s natural defense to lower the chances of getting certain diseases as well as suffering complications from these dis- eases. Vaccines lower your chance of spreading certain diseases There are many things you want to pass on to your loved ones; a vaccine preventable disease is not one of them. Infants, older adults, and people with weakened immune systems (like those undergoing cancer treatment) are especially vulnerable to vaccine preventable diseases.

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 81 Vaccines are one of the safest ways to protect your health Vaccine side effects are usually mild and go away on their own. Severe side effects are very rare. Getting vaccinated Adults can get vaccines at doctors’ offices, pharmacies, workplaces, commu- nity health clinics, health departments, and other locations. To find a vac- cine provider near you, go to vaccine.healthmap.org. Most health insurance plans cover the cost of recommended vaccines. Check with your insurance provider for details and for a list of vaccine providers. If you do not have health insurance, visit www.healthcare.gov to learn more about health coverage options. What vaccines do you need? All adults should get: • Flu vaccine every year to protect against seasonal flu • Td/Tdap to protect against tetanus, diphtheria, and pertussis (whooping cough) Based on your age, health conditions, vaccines you received as a child, and other factors, you may need additional vaccines such as: • Chickenpox • Hepatitis A • Hepatitis B • Human Papillomavirus (HPV) • MMR • Meningococcal

82 MOHAMADOU M. DIENE • Pneumococcal • Shingles Traveling overseas? There may be additional vaccines you need. Find out at: www.cdc.gov/travel TAKE STEPS TO GOOD HEALTH Be physically active and make healthy food choices. Learn how at http://www.healthfinder.gov/HealthTopics/nutrition-and-physical-activity. Get to a healthy weight and stay there. Balance the calories you take in from food and drink with the calories you burn off by your activities. Be tobacco free. For tips on how to quit, go to http://www.smokefree.gov. To talk to someone about how to quit, call the National Quitline: 1-800- QUITNOW (784-8669). If you drink alcohol, have no more than two drinks per day if you are 65 or younger. If you are older than 65, have no more than one drink a day. Get Preventive tests Healthy men Screening tests can find diseases early, when they are easiest to treat. Talk to your doctor about which preventive medical tests you need to stay healthy. Body Mass Index. Your body Mass Index, or BMI, is a measure of your body fat based on your height and weight. It is used to screen for obesity. You can find your BMI by visiting http://www.nhlbisupport.com/bmi. Cholesterol. Once you turn 35 (or once you turn 20 if you have risks factors

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 83 like diabetes, history of heart disease, tobacco use, high blood pressure, or BMI of 30 or over), have your cholesterol checked regularly. High blood cholesterol is one of the major risk factors of heart disease. Blood pressure. Have your blood pressure checked regularly. High blood pressure increases your chance of getting heart or kidney disease and for having a stroke. If you have high blood pressure, you may need medication to control it. Cardiovascular disease. Beginning at age 45 and through age 79, ask your doctor if you should take aspirin every day to help lower your risk of heart attack. How much aspirin you should take depends on your age, your health, and your lifestyle. Colorectal cancer. Beginning at age 50 and through age 75, get tested for colorectal cancer. You and your doctor can decide which test is best. How often you’ll have the test depends on which test you choose. If you have a family history of colorectal cancer, you need to be tested before you turn 50. Other cancers. Ask your doctor if you should be tested for prostate, lung, oral, skin, or other cancers. Sexually Transmitted diseases. Talk to your doctor to see whether you should be tested for gonorrhea, syphilis, chlamydia, or other sexually trans- mitted diseases like HIV. Your doctor may recommend screening for HIV if you: • Have sex with men. • Had unprotected sex with multiple partners. • Have used injected drugs.

84 MOHAMADOU M. DIENE • Pay for sex or have sex partners who do. • Have past or current sex partners who are infected with HIV. • Are being treated for sexually transmitted diseases. • Had a blood transfusion between 1978 and 1985. Depression. If you have felt “down” or hopeless during the past two weeks or you have had little interest in doing things you usually enjoy, talk to your doctor about depression. Depression is a treatable illness. Abdominal Aortic Aneurysm. If you are between the ages of 65 and 75 and have smoked 100 or more cigarettes in your lifetime, ask your doctor to screen you for an abdominal aortic aneurysm. This is an abnormally large or swollen blood vessel in your stomach that can burst without warning. Diabetes. Ask your doctor to test you for diabetes, mostly If your blood pressure is higher than 135/80. Diabetes, or high blood sugar, can cause problems with your heart, eyes, feet, kidneys, nerves, and other body parts. Tobacco use. If you smoke or use tobacco, talk to your doctor about quitting. For tips on how to quit, go to http://www.smokefree.gov, or call the National Quitline at 1-800-QUITNOW.

CHAPTER 13 WOMEN: STAY HEALTHY AT ANY AGE Use this information to help you stay healthy. Learn which screen- ing tests you need and when to get them, which medicines may prevent diseases, and steps you can take for good health. GET THE SCREENING YOU NEED Screenings are tests that look for diseases before you have symptoms. Blood pressure checks and mammograms are examples of screenings. Breast cancer. Talk with your health care team about whether you need a mammogram. The United States Preventive Services Task Force recommends

86 MOHAMADOU M. DIENE that average-risk women who are 50 to 74 years old should have a screening mammogram every two years. Average-risk women who are 40 to 49 years old should talk to their doctor about when to start and how often to get a screening mammogram. BRCA 1 and 2 Genes. If you have a family member with breast, ovarian, or peritoneal cancer, talk to your doctor or nurse about your family history. Women with a strong family history of certain cancers may benefit from genetic counseling and BRCA genetic testing. Cervical cancer. Starting at age 21, get a Pap smear every 3 years until you are 65 years old. Women 30 years of age or older can choose to switch to a combination Pap smear and human papillomavirus (HPV) test every 5 years until the age of 65. If you are older than 65 or have a hysterectomy, talk with your doctor or nurse about whether you still need to be screened. Colon cancer. Between the ages of 50 and 75, get a screening test for colo- rectal cancer. Several tests- for example, a stool test or a colonoscopy-can detect this type of cancer. Your health care team can help you decide which test is best for you. If you are between the ages of 76 and 85, talk to your doctor or nurse about whether you should continue to be screened. Depression. Your emotional health is as important as your physical health. Talk to your health care team about being screened for depression, espe- cially if during the past two weeks: • You have felt down, sad, or hopeless. • You have felt little interest or pleasure in doing things. Diabetes. Get screened for diabetes (high blood sugar) especially if you have high blood pressure or if you take medication for high blood pressure. Di- abetes can cause problems with your heart, brain, eyes, feet, kidneys, nerves,

MAKING THE MOST OF YOUR DOCTOR’S APPOINTMENT 87 and other body parts. Hepatitis C virus (HCV). Get screened one time for HCV infection if: • You were born between 1945 and 1985 • You have ever injected drugs • You received blood transfusion before 1992. If you currently are an injection drug user, you should be screened regu- larly. You know your body better than anyone else. Always tell your health care team about any changes in your health, including your vision and hear- ing. Ask them about being checked for any condition you are concerned about, not just the ones mentioned here. If you are wondering about diseases such as Alzheimer’s disease or skin cancer, for example, ask about them. High blood cholesterol. Have your blood cholesterol checked regularly with a blood test if: • You use tobacco. • You are overweight or obese. • You have a personal history of heart disease or blocked arteries. • A male relative in your family had a heart attack before age 50 or a female relative, before age 60. High blood pressure. Have your blood pressure checked regularly. High blood pressure can cause strokes, heart attacks, kidney and eye problems. HIV. If you are 65 or younger, get screened for HIV. If you are older than 65, ask your doctor or nurse whether you should be screened. Lung cancer. Talk to your doctor or nurse about getting screened for lung cancer if you are between the ages of 55 and 80, have a 30 pack-year smoking

88 MOHAMADOU M. DIENE history, and smoke now or have quit within the past 15 years. (Your pack- year history is the number of packs of cigarettes smoked per day times the number of years you have smoked.) Know that quitting is the best thing you can do for your health. Overweight and Obesity. The best way to learn if you are overweight or obese is to find your body mass index (BMI). You can find your BMI by entering your height and weight into a BMI calculator, such as the one available at: http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm. A BMI between 18.5 and 25 indicates a normal weight. Individuals with a BMI of 30 or higher may be obese. If you are obese, talk to your doctor or nurse about getting intensive counseling and help changing your behav- iors to lose weight. Obesity can lead to diabetes and cardiovascular disease. Osteoporosis (Bone thinning). Have a screening test at age 65 to make sure your bones are strong. The most common test is a DEXA scan, a low dose x-ray of the spine and hip. If you are younger and at risk for bone fractures, you should also be screened. Talk with your health care team about your risk for bone fractures. Sexually transmitted infections. Sexually transmitted infections can make it hard to get pregnant, may affect your baby, and can cause other health problems. • Get screened for chlamydia and gonorrhea infections if you are 24 years or younger and sexually active. If you are older than 24 years, talk to your doctor or nurse about whether you should be screened. • Ask your doctor or nurse whether you should be screened for other sexually transmitted infections.