Is Your Doctor Listening to You?

Contributing Author: Alice Krueger

Research into doctor-patient communication has shown that the average time a doctor listens to a patient before interrupting is between 12 and 23 seconds. That’s not enough time for anyone to express their concerns about their health and wellness.

What can you do to address this situation? Part of the answer lies in your preparation, and the rest in how you act while in the doctor’s office.

Before the date of the office visit, write down your concerns and questions. Update your note to yourself as more thoughts come to you that you might want to share. Prioritize everything on your list. You probably won’t have time to go through the whole set of concerns in one visit, so be sure the most important issues are addressed first.

When the doctor enters the exam room, offer a handshake and friendly short greeting. This helps make an honest human connection. Doctors generally respond well to common courtesies.

It is important that you understand everything the doctor is saying to you. Don’t hesitate to ask her to repeat what she said, or you can say it back to her in your own words and ask if that is correct. You also can ask her to put it in writing, especially is she’s using specialized terminology.

Many doctors have email accounts, so ask yours for the address where you can send questions that you think of after the appointment ends.

You always have the right to a second opinion, of diagnoses and of suggested treatments. Ask your doctor if he would recommend someone to provide a second opinion. Be suspicious if he says you don't need one, or only suggests others in his group practice.

It’s important to be honest with your doctor. Let her know if you can’t afford the suggested treatment. She may have options that would be more affordable. Also, tell her if for some reason you can’t follow her directions. If she’s recommending three sessions a week and transportation is an issue, speak up. If she says you should quit smoking, and you’re tried and failed several times before, admit it.

Last but not least, be sure your doctor is aware of your Advance Directive. Ask him if he has a copy in your file. If he’s not sure, hand him another printed copy. And then give the receptionist another copy on the way out and ask him to put it in your record.

With these preparations and actions, your doctor is more likely to hear what you have to say.

Image Source: Pixabay - Patient Care and Pixabay - Patient Care 2

September is National Yoga Month

Yoga is a mind-body exercise that combines both active (moving) and passive (held) poses and stretches with specific breathing and relaxation techniques. Yoga exercises can be done individually or as a class.

Yoga originated in India in the 6th or 5th centuries BCE as a meditative spiritual practice and philosophical discipline. Many styles or schools of yoga exist: hatha, iyengar, kundalini, bikram, etc. You will want to try different styles to see which one best meets your needs.

Simple yoga exercises are a great way to calm your nerves from daily stress.
Calm your nerves with relaxation exercises: http://www.everydayhealth.com/emotional-health/mini-relaxations.aspx?pos=1&xid=nl_EverydayHealthWomensHealth_20160810.

Yoga can stretch and strengthen muscles, and may be used as part of recreational therapy following hospitalizations.
Pain rehabilitation: http://www.mayoclinic.org/pain-rehabilitation/art-20208636?utm_source=newsletter&utm_medium=email&utm_campaign=pain-management.

Yoga can be part of an integrated therapeutic approach to chronic pain. It allows you to have more control over your response to pain, because it is an active therapy that you can use whenever it is needed.
Integrative Approaches to Pain: http://www.mayoclinic.org/integrative-approaches-to-treating-pain/art-20208637?utm_source=newsletter&utm_medium=email&utm_campaign=pain-management.
Beyond Opioids: Other options for treating chronic pain - http://www.everydayhealth.com/columns/health-answers/beyond-opioids-other-options-treating-chronic-pain/?xid=nl_EverydayHealthLivingWithChronicPain_20160908.

Yoga can even help you sleep better! It is an effective relaxation exercise to try before bedtime.
Remedies for sleep problems due to aging: http://www.everydayhealth.com/sleep/insomnia/tips/seniors-dont-take-sleep-woes-lying-down.aspx?pos=1&xid=nl_EverydayHealthWomensHealth_20160821.

Yoga has been recommended in the treatment of health conditions as disparate as:

• the symptoms of multiple sclerosis
  How yoga helps multiple sclerosis: http://www.everydayhealth.com/multiple-sclerosis/living-with/how-yoga-helps-multiple-sclerosis/?xid=nl_EverydayHealthLivingWithMultipleSclerosis_20160806,
• chronic kidney disease
  Exercise training for adults with chronic kidney disease: http://www.cochrane.org/CD003236/RENAL_exercise-training-for-adults-with-chronic-kidney-disease,
• the stress and anxiety caused by obsessive-compulsive disorder (OCD)
  What Is Obsessive-Compulsive Disorder (OCD)? http://www.everydayhealth.com/obsessive-compulsive-disorder/guide/,
• lowering cholesterol (if you work at an aerobic level)
  Top exercises to lower your cholesterol: http://www.everydayhealth.com/high-cholesterol/top-exercises-to-lower-your-cholesterol.aspx,
• urinary incontinence
  A group-based yoga therapy intervention for urinary incontinence in women: https://www.ncbi.nlm.nih.gov/pubmed/24763156,
• constipation
  For suggested helpful poses: http://www.everydayhealth.com/columns/everyday-fitness/exercises-to-ease-constipation/?xid=nl_EverydayHealthLivingWithMultipleSclerosis_20160326,
• depression
  Effects of yoga versus walking on mood, anxiety, and brain GABA levels http://online.liebertpub.com/doi/abs/10.1089/acm.2010.0007, and
• osteopenia and osteoporosis
  Twelve-minute daily yoga regimen reverses osteoporotic bone loss: http://journals.lww.com/topicsingeriatricrehabilitation/Citation/2016/04000/Twelve_Minute_Daily_Yoga_Regimen_Reverses.3.aspx

Your local library may have books or DVDs about yoga. You can find many articles and videos describing various yoga exercises online. Here are a few to get you started.

• Yoga Poses for Beginners
• Seated Yoga

For more potential benefits of yoga, please see:
11 Unexpected Health-Promoting Benefits of Yoga

As with all physical activities, please check with your healthcare professional to be sure you are ready to begin doing yoga.

Humpday Hint: How Sharp is Your Hearing? As Sharp as Your Mind?

Contributing Author: Alice Krueger

Maybe you think that hearing loss is inevitable with aging. Did you know that maintaining your hearing as you age can protect your brain health?

Older adults with good hearing were found to be more mentally fit than older adults with hearing loss in research conducted around the world ¹. However, the causal link between hearing loss and dementia is not yet understood ².

In terms of quality of life, older adults who sought treatment for hearing loss had a higher level of satisfaction than those who did not ³. This may be due to improved social and emotional functioning and communication capabilities ⁴.

There is little to be risked by getting assessed for age-related hearing loss, and treating it has definite health benefits ⁵.

What are you waiting for?

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Resources

1. Davies, H. R., Cadar, D., Herbert, A., Orwell, M. & Steptoe, A. (2017). Hearing impairment and incident dementia: Findings from the English Longitudinal Study of Ageing. Journal of the American Geriatrics Society, prepub; Deal, J. A., Betz, J., Yaffe, K., Harris, T., Purchase-Helzner, E., Satterfield, S., et al. (2017). Hearing impairment and incident dementia and cognitive decline in older adults: The Health ABC Study. The Journals of Gerontology. Series A, Biological sciences and medical sciences, 72(5), 703-709; Heywood, R., Gao, Q., Nyunt, M. S. Z., Feng, L., Chong, M. S., Lim, W. S., et al. (2017). Hearing loss and risk of mild cognitive impairment and dementia: Findings from the Singapore Longitudinal Ageing Study. Dementia and Geriatric Cognitive Disorders, 43(5-6), 259-268.
2. Lin, V. Y. W. & Black, S. E. (2017). Linking deafness and dementia: Challenges and opportunities. Otology & Neurotology, 38(8), e237-e239.
3. Manrique-Huarte, R., Calavia, D., Huarte Irujo, A., Giron, L. & Manrique-Rodriguez, M. (2016). Treatment for hearing loss among the elderly: Auditory outcomes and impact on Quality of Life. Audiology & Neuro-otology, 21 Suppl 1, 29-35; Yamada, Y., Svejdikova, B. & Kisvetrova, H. (2017). Improvement of older-person-specific QOL after hearing aid fitting and its relation to social interaction. Journal of communication disorders, 67, 14-21.
4. Fortunate, S., Forli, F., Guglielmo, V., De Corso, E., Paludetti, G., Berrettini, S., et al. (2016). A review of new insights on the association between hearing loss and cognitive decline in ageing (in Italian). Acta Otorhinolaryngologica Italica, 36(3), 155-166.
5. Golub, J. S. (2017). Brain changes associated with age-related hearing loss. Current Opinion in Otolaryngology & Head & Neck Surgery, prepub.

Image Credit: Wikimedia Commons

Psoriasis: More Than Skin Deep

Contributing Author: Alice Krueger

Visibly, psoriasis is an itchy skin condition with sore red patches of thickened dry skin, called plaques. These plaques occur most often on the scalp, face, elbows, palms, back, knees and feet. Psoriasis is an autoimmune disease in which the patient’s body attacks healthy skin cells, causing inflammation that leads to changes in skin structure and function.

Psoriasis is an unpredictable condition. Some people have remissions lasting several months without symptoms. Flares of increased symptoms seem to happen without warning and can be any severity level. Flares can be caused by stress, cold weather, dry skin, colds and respiratory infections, and smoking.

There is no known cure for psoriasis; treatment is symptomatic, striving to slow down the growth of skin cells. Topical treatments are the first intervention to be prescribed. These can be over-the-counter items (lotions containing salicylic acid or coal tar to cause skin shedding, or lotions containing aloe vera or jojoba to moisturize the skin) or by prescription. Nonsteroidal topical prescriptions containing synthetic vitamin A or D3 slow the production of skin cells. Corticosteroid prescriptions can thin the skin.

Biologic drugs for psoriasis are derived from live cell cultures and are administered by injection or IV. They block the action of the immune system that is overactive and misdirected in psoriasis. Phototherapy focuses UV or laser light on affected skin areas. Systemic medications, usually reserved for people with moderate or severe psoriasis, are taken in pill form or by injection. They work throughout the body, not just at the site of the psoriasis.

Psoriasis is associated with common symptoms of emotional distress, including sleep disorders and general anxiety ¹. This indicates a lowered quality of life. The National Psoriasis Foundation states that 24% of people with psoriasis also have depression ², which can lead to numerous other health and wellness issues. Young adults with psoriasis are at increased risk for suicide ³, especially if it causes them significant emotional distress, impairs their daily activities, causes them to have a negative body image or creates difficulty in establishing or maintaining close relationships.

Other serious health issues may be related to psoriasis. Although it is not clear which is cause and which is effect, metabolic syndrome is found in 40% of persons with psoriasis ⁴ while only 21% of the general population has this set of health problems. Metabolic syndrome is indicated by high blood pressure, high triglycerides, low HDL (“good”) cholesterol, high blood sugar, and too much fat around the waist. The increased risk of persons with psoriasis having metabolic syndrome may explain their increased risk for cardiovascular disease, obesity, and cancer.

The link between psoriasis and cardiovascular disease seems to lie in the inflammatory response ⁵. Inflammation can damage blood vessels, resulting in the formation of plaques (not the same kind as psoriasis plaques) in arteries leading to the heart. This can result in heart attacks or strokes.

People with psoriasis whose treatment included biological agents or methotrexate had lower rates of cardiovascular disease than did those with other treatment regimens ⁶. This might be due to systemic treatments reducing proteins that signal inflammation.

The direction of the relationship between obesity and psoriasis is unclear, and there is little evidence that diet affects psoriasis. However, a study showed that obesity increases both the risk of getting cardiovascular disease and of having psoriasis ⁷. Therefore it is doubly important to eat a healthy diet if you have psoriasis.

A study in the UK found an increased risk for psoriasis patients to get lymphoma, non-melanoma skin cancer and other cancers ⁸. The cancer risk seemed highest for those who received systemic treatments (e.g., phototherapy or methotrexate). It is important for persons with psoriasis to avoid risk behaviors that can lead to cancers, including smoking, excessive sun exposure, and alcohol abuse.

If you have psoriasis, it is wise to keep up with regular screenings for other health conditions, including depression. Ask your dermatologist to help you create a preventive program based on your medical history and additional risk factors.

To learn more about psoriasis during the month of August, visit the exhibit on Healthinfo Island in Second Life (SLURL: http://maps.secondlife.com/secondlife/Healthinfo%20Island/98/41/26 ).

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Resources

1. Pärna, E., Aluoja, A. & Kingo, K. (2015). Quality of life and emotional state in chronic skin disease. Acta Dermato-Venereologica, 95(3), 312-316.
2. Kimball, A. B., Gladman, D., Gelfand, J. M., Gordon, K., Horn, E. J., Korman, N. J., et al. (2008). National Psoriasis Foundation clinical consensus on psoriasis co-morbidities and recommendations for screening. Journal of the American Academy of Dermatology, 58(6), 1031-1042.
3. Picardi, A., Lega, I. & Tarolla, E. (2013). Suicide risk in skin disorders. Clinics in Dermatology, 31(1), 47-56.
4. Love, T. J., Qureshi, A. A., Karlson, E. W., et al. (2011). Prevalence of the metabolic syndrome in psoriasis: Results from the National Health and Nutrition Examination Survey, 2003-2006. JAMA Dermatology, 147(4), 419-424.
5. Gu, W.-J., Weng, C.-L., Zhao, Y.-T., Liu, Q.-H. & Yin, R.-X. (2013). Psoriasis and risk of cardiovascular disease: A meta-analysis of cohort studies. International Journal of Cardiology, 168(5), 4992–4996.
6. Aheloff, O., Skov, L., Gislason, G., Lindhardsen, J., Kristensen, S. L., Iversen, L., et al. (2012). Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: A Danish real-world cohort study. Journal of Internal Medicine, 273(2), 197-204.
7. Carrascosa, J. M., Rocamora, V., Fernandez-Torres, R. M., Jimenez-Puya, R., Moreno, J. C., Coll-Puigserver, N., et al. (2014). Obesity and psoriasis: Inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications (in Spanish). Actas Dermo-Sifiliográficas, 105(1), 31-44.
8. Fuxench, Z. C. C., Shin, D. B., Beatty, A. O. & Gelfand, J. M. (2016). The risk of cancer in patients with psoriasis: A population-based cohort study in the Health Improvement Network. JAMA Dermatology, 152(3), 282-290.

Image Credit: Wikimedia Commons