Slightly Creaky is pleased to have partnered with Emeritus Corporation to provide these articles devoted to Senior issues, from health and long-term care to active living. The variety of articles that will be presented here have been selected by the Slightly Creaky editors specifically for our viewers

Our policy prevents us from recommending any commercial enterprise. The folks at Emeritus Corporation understand this. You will find no commercials on this Web site, to Emeritus or any other for-profit organization. For your convenience, we do provide a link to their site so you can get more information should yo so desire.

Index to Current Articles

January, 2011: Dangers of Winter Weather
February, 2011: Assisted Living Services Are Tax-Deductible
March, 2011: How do I get my Parent to Tell the Doctor?
April, 2011: How Do I Respond When A Loved One Calls Me In A Crisis?
May, 2011:Could These Dark Moods Be Depression?
June, 2011: What Skills are Needed for Independent Living?
July, 2011: Eldercare Guide to Diabetes. Part 1
August, 2011: Eldercare Guide to Diabetes. Part 2
September, 2011: Eldercare Guide to Diabetes. Part 3
October, 2011: Eldercare Guide to Diabetes. Part 4
November, 2011: Eldercare Guide to Diabetes. Part 5
December, 2011: Stroke (Part 1 of 5) Signs and Symptoms
January, 2012: Stroke (Part 2 of 5) Risks
February, 2012: Stroke (Part 3 of 5): Causes

Articles © Emeritus Corporation. Used with permission

(For articles prior to 2011, visit www.emeritus.com.)

Dangers of Winter Weather

Dangers of Winter Weather

Are you afraid of tripping and falling due to the weather conditions outside?

As the weather gets cooler and the rain and snow start to fall, many seniors leave their homes more often during the day. Dangerous driving, unsafe walking conditions and housing hazards can be worrisome on families.

Review our safety tips below to help keep you and your family safe this season.

Home Safety Tips

• Don't hide keys under the doormat, in the mailbox or in a planter.
• Make sure the street number on your house is large, well-lit and unobstructed so emergency personnel can find your home quickly.
• Purchase an ABC multipurpose fire extinguisher for the home. Check yearly to verify the extinguisher is working.
• Keep anything flammable at least three feet away from any space heater. New space heaters shut off automatically if the heater falls over.
• Close fireplace doors or place a screen in front of a wood burning fire to catch flying sparks and rolling logs.

Auto Safety Tips

• Get your car in peak operating condition for the fall before driving in rainy or snowy conditions.
• Tires: Check the tire presssure and make sure your tires have sufficient tread.
• Radiator: Have the anti-freeze levels checked.
• Belts: Inspect the belts and hoses for cracks or leaks.
• Oil: Ask your mechanic about switching to a thinner grade of engine oil for better performance in colder temperatures.
• Wipers: Inspect the windshield wipers and wiper fluid to ensure better visibility.
• Battery: Make sure the battery is fully charged.
• Drive according to road conditions. If roads are wet by snow or rain, slow down.

Outdoor Safety Tips

• Wear shoes that are flexible, non-skid with Velcro straps. Do not assume the walkways are not slippery.
• Make sure all walkways around your home are well-lit.
• Avoid walking on wet leaves that have fallen, they can be very slippery.
• Beware of black ice; especially melted snow runoff from cars can cause black ice when water freezes over.
• Dress for cooler temperatures by covering exposed skin and wearing water proof clothing.
• Remember, hats stop body heat from escaping.
  

Other Safety Tips

• Be aware of the environment conditions surrounding you before putting yourself in a situation where injury is possible.
• Slow Down - rushing can cause unnecessary risks.
• Don't carry large amounts of cash or unneeded credit cards.
• Sit near the driver or the exit when riding on a bus, train or subway.
• Use a direct deposit service for Social Security and other regular checks.

Assisted Living Services Are Tax-Deductible

Assisted Living Services Are Tax-Deductible

Medical expenses can really add up. Did you know that there may be a way to write off those assisted living expense as a tax-deductible medical expenses at tax time? Such information gives providers another tool regarding the affordability of assisted living when working with seniors and their family members,

Under HIPAA, expenses can be tax-deductible if such services are provided pursuant to a plan of care prescribed by a licensed health-care practitioner, and the personal care services are required by a person who:

• is unable to perform at least two activities of daily living, or

• has severe cognitive impairment and requires supervision to protect self and others from health and safety threats. Under IRS rules Alzheimer's is categorized as a severe cognitive impairment, and is therefore fully tax deductible as a medical expense.

TAX DEDUCTION FOR MEDICAL EXPENSES
Deductions for medical expenses may be claimed whenever the total cost of these expenses
exceeds 7.5 % of your adjusted gross income for the year. This applies to:

• The costs of diagnosis, cure, mitigation, treatment, or prevention of disease, and the cost for treatments affecting any part or function of the body.

• The alleviation or prevention of a physical or mental defect or illness.

• The costs of equipment, supplies and diagnostic devices needed for these purposes.

• Dental expenses

• Premiums you pay for insurance that covers the expenses of medical care, and the amounts you pay for transportation to get medical care.

• Amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.

How do I get my Parent to Tell the Doctor?

How do I get my Parent to Tell the Doctor?

by Vicki Rackner MD

Imagine your partner says, “Honey, let’s pack a picnic lunch, grab the kids and head to the topless beach.” You’re not sure you want to be exposed in that way, especially in front of the kids.

This may be what it’s like for your parents when you suggest they tell the doctor about the aches and pains they so freely share with you.

You don’t want you parents to suffer. You want the information about their symptoms to get into the hands of the people who can help them: their doctors. You may have tried to persuade your parents any number of times.

Here are some things that may not have worked:

“How to” instructions. You may have said, “Mom, just call the doctor and leave a message the pill is too big. It gets stuck. Ask what they can do.” This is like saying, “The way to get the top off is to untie the string and unhook the back.” The mechanics—how to walk through the steps—are usually not the problem.

The “Everybody does it” argument. Would this persuade you to change your mind about topless bathing? While it may be normal for people to speak up with their doctors, it’s not normal for your parents.

Logic arguments. It’s unlikely your partner could change your mind by saying, ”Topless beaches are great. No tan lines. One less thing to pack when we go on vacation. And think of the money we’ll save buying only half of the bikini.” You can create compelling arguments to your parents, like speaking up will prevent medical errors and lower prescription costs. Often, though, even these benefits do not outweigh their heavy source of resistance.

Here’s the problem in a nutshell. The way your parents interact with their doctors is deeply engrained behavior. They see speaking up as disrespectful.

Here are some strategies that may work better:

Ask, “Is it possible?” Can you ever imagine your parents speaking up with the doctors? In my experience 80% of patients over 80 will simply never change the way they work with the doctor.

Ask, “What can I do differently?” If your parents won’t get vital information into the hands of the doctor, you can ask if you can. Say, “Mom, I know you hope the doctor will ask you about your bowel habits, and then you can tell him about your constipation. This is too important to leave to chance. May I call the doctor and tell him, or come with you to your next appointment?”

Ask, “Why is it important for the doctor to know?” You most likely want the doctor to know about your parents’ symptoms in hopes of change for the better. Many of the aches and pains your parents tell you about are a result of normal wear-an-tear on the body. The goal is to improve the quality of their lives. There are many people who can help, including pharmacists, nurses, physical therapists and families who have walked in your shoes. It could be a new gizmo could restore some function in arthritic hands. Be sure to include all of these important people in your team.

Tip: If your parents want you to participate in their medical care, make sure they tell their doctors. You can ask the doctor to document this in the chart.

About Dr. Vicki

Vicki Rackner, MD is a board-certified surgeon and clinical faculty member at the University of Washington School of Medicine. She left the operating room to be on the cutting edge of healthcare consumerism. She is now a full-time patient advocate, helping people get the health care they want, need and deserve. Dr. Vicki is an author, speaker and consultant.

How Do I Respond When A Loved One Calls Me In A Crisis?

How Do I RespondWhen A Loved One

Calls Me In A Crisis?

by Vicki Rackner MD

Toni’s mom called in a state of panic from the hospital. She fell and broke her hip. Her biggest concern is her cat. Who will feed her cat and give her cat his medicine? Toni peppered her mother with questions about her hip, and her mother got increasingly annoyed. “You don’t understand. The doctor is taking care of my hip. I want you to take care of my cat.” It was only after Toni reassured her mother that she would look after the cat that she got her mother’s medical update.

The heart of caregiving is plugging onto a loved one’s agenda. When the helper “gets” the person in need, the crisis gets diffused; when they go off on their own take of the problem, the crisis is escalated. It’s Toni’s ability to reassure her mother about the cat before addressing the hip.
Here are some thoughts if you are on the receiving end of a call from a person in crisis:

Are you speaking words that the person in crisis can hear in a way that they can hear them?

Not helpful: “Here’s what I have to do before I can help you” followed by a laundry list of your own personal challenges.

Helpful: “Sounds like a serious problem. I’m here and we’ll get it solved!” Are you able to see more than one way to fix the problem?

Not helpful: “The doctor says you need an operation. You’ll get the operation. It’s the only way.”

Helpful: “It sounds like you want to avoid an operation. There are always options. Let’s get a second opinion.” What problem are you trying to fix? Are you addressing what’s important for you or what’s important for the person in need?

Not helpful: “ Who cares about your cat; it’s only a cat. I care about you.”

Helpful: “We’ll make sure that your cat gets his food and medicine on time.” Do you deliver a helping hand or blame?

Not helpful: “You’re in the ER with a heart attack! I TOLD you should have stopped smoking.”

Helpful: “I’ll be right there.” Then have the conversation about smoking after the dust settles.
Are you making good on your promises?

Not helpful: “I’ll call you back” or make other promises you break then ignore.

Helpful: Try to only make promises you can keep, try to keep them and take responsibility if you cannot. Is your timing right?

Not helpful: Rush into the ER and say, “You were on the ground two hours before someone found you after you fell. This is exactly why I want you to move in with me.”

Helpful: Wait until the time is right after the hip operation.

About Dr. Vicki - Vicki Rackner, MD is a board-certified surgeon and clinical faculty member at the University of Washington School of Medicine. She left the operating room to be on the cutting edge of healthcare consumerism. She is now a full-time patient advocate, helping people get the health care they want, need and deserve. Dr. Vicki is an author, speaker and consultant.

Could These Dark Moods Be Depression?

Could These Dark Moods Be Depression?

by Vicki Rackner MD

Everybody has days that bring sadness, low energy, or aches and pains. Maybe you see it in your aging parents, your partner, or even in yourself. While all of these symptoms are an expected part of normal life, they can also be symptoms of clinical depression.

Clinical depression is a real illness that causes real pain. You’ve seen enough TV ads to know that depression is associated with a chemical imbalance in the brain. Depressed people describe unwanted moods and thoughts that don’t lead anywhere productive. One caregiver said, “It’s like my thoughts get stuck driving around a traffic circle, and I can’t find a way out.”

The relationship between thoughts and mood are like the chicken and the egg. Each thought creates a chemical reaction in the brain, then the chemical reactions influence the thoughts the brain chooses. The treatment of depression involves changing the brain chemistry with medication and offering skills about how to choose your thoughts.

Family caregivers are twice as likely to be diagnosed with depression as their non-caregivign peers; the elderly get depressed much more often than previously imagined. Clinical depression is treatable in the young and the old and everyone in between. It must be diagnosed before it’s treated.

Ask the doctor, “Could I be depressed?” If you’re a caregiver, you know that feeling sad or overwhelmed is a normal response to super-sizing your job caring for others. Your doctor can distinguish an expected under-the-weather mood from true clinical depression.

Sometimes it’s easy to make the diagnosis of depression, and other times it’s tricky. Sometimes disorders of the mind, such as depression, can manifest as aches and pains in the body, and other times disorders of the body, such as thyroid problems, can manifest as mood changes.

People of your parents’ generation resist the diagnosis of depression because they believe that there is shame associated with problems of the mind. You can suggest, “You would not be ashamed if you had appendicitis or the flu or needed eyeglasses. Depression is just another illness that affects a different organ system.”

Go play. Your grandmother was right. Regular exercise benefits the mind and the body. Exercise changes the brain chemistry in a way that improves sad moods. Even a 10-minute walk can make a positive difference. Park a little farther away from work or the store. Take the stairs instead of the elevator. You will reap many rewards, including a sound night’s sleep.

Use your stress-busters. Let’s face it: caregivers live with lots of stress. While you may not be able to control the stress in your life, you decide how you respond to the stress. Make a list of 5 things you can do when you feel stressed. Maybe it’s taking that brisk walk or writing in your journal or calling a friend. The time you most need stress-busters is the time you’re most likely to forget them, so put the list on the fridge.

Rethink people-pleasing. People-pleasers go to great lengths to make others happy. They often care for others at their own expense; many take pride in their ability to ignore their own needs. They run the risk of depression both from the lack of self-care and from the futility of efforts to make another person happy. Attending to your own needs puts you in a better position to nurture others.

Reach out to others. Connect with friends who are good listeners. If getting out of the house is impossible, join an online community. Tell your story and see chapters of your own story told by others.

Redefine hope. It may be true that cure may not be an option, but there’s always hope. Capture the joy that’s always there.

About Dr. Vicki

Vicki Rackner, MD is a board-certified surgeon and clinical faculty member at the University of Washington School of Medicine. She left the operating room to be on the cutting edge of healthcare consumerism. She is now a full-time patient advocate, helping people get the health care they want, need and deserve. Dr. Vicki is an author, speaker and consultant.

What Skills are Needed for Independent Living?

What Skills are Needed for Independent Living?

As we age, tasks that were once manageable can become difficult or impossible to perform without assistance. When the basics of daily life become overwhelming, seeking help from trained professionals, either through home care or a residential assisted living facility, can allow individuals to live higher quality, less stressful lives.

The decision to enter an assisted living facility or to allow a caregiver into the home is often incredibly difficult, however. You may wonder if things are really "bad enough" to justify the choice. To help make an objective decision, read on to find out exactly what abilities are necessary for individuals to live safely on their own.

Activities of Daily Living
Activities of daily living (ADL) are the things we normally do on a daily basis, including any daily activity we perform for self-care.[1] These are tasks that are absolutely necessary for someone to live independently. The following are examples of ADLs.[2]

• Bathing
• Dressing and undressing
• Eating
• Transferring from bed to chair, and back
• Voluntarily control of urinary and fecal discharge
• Using the toilet

Walking (not bedridden)

For some individuals, performing these activities is simply a matter of making some home modifications such as installing grab bars in the bathing area. However, if someone you know is having difficulties with three or more of the above, he or she may be a good candidate for nursing home care. [3][4]

An occupational therapist can help you determine whether modifications alone will provide an individual with adequate resources to perform ADL.Instrumental Activities of Daily Living
Unlike the tasks listed above, instrumental activities of daily living (IADLs) are not absolutely necessary for fundamental functioning, but they allow an individual to live independently within a community. The following are the six IADLs.[5]

• Light housework
• Preparing meals
• Taking medications
• Shopping for groceries or clothes
• Using the telephone
• Managing money

About one-fourth of nursing-home residents need help with one or two IADLs and three-fourths need assistance with three or more. More than half of residents are incontinent (meaning they have problems using the bathroom), and more than a third have difficulty with hearing or seeing.[3]
As these activities become more difficult, an individual may find that entering residential care that allows an independent lifestyle while providing help with the chores of daily life provides a greater quality of life than living alone. Such individuals may want to investigate independent living communities or assisted living facilities.

Cognitive Capabilities
Cognitive capabilities are abilities that involve thinking and reasoning. Cognitive disorders, such as Alzheimer's disease and other dementias, can affect an individual's ability to perform activities necessary for independent living. People affected by dementia can experience gradual deterioration of intellectual abilities and behavior that eventually interferes with customary daily living activities. They may have problems with tasks such as balancing the checkbook, driving the car, and socializing with others.[3]

About 50 percent to 70 percent of nursing home residents are affected by dementia.[3] Additionally, more than three-fourths of nursing home residents have difficulty making daily decisions, such as what to have for dinner, and two-thirds have problems with memory or knowing where they are occasionally.[3]

In the earliest stages of dementia, independent living is often possible. However, asthe disease progresses, it becomes stressful and dangerous for an individual to live alone. An assisted living facility will provide a safe environment that includes easy-to-navigate floor plans to help minimize disorientation. Some specialized facilities also include programs that provide activities and exercises to slow the progress of the disease.

If your loved one is no longer able to perform the necessary skills to live independently, Emeritus can provide him or her with a safe and nurturing environment. With a variety of options including adult day care, assisted living, and Alzheimer's care, we meet each individual's needs while maximizing autonomy.

For More Information
Learn more about independent living services and independent living communities at Emeritus.
References

1. MedicineNet.com. (October 21, 1998). Definition of ADLs (activities of daily living). Retrieved June 17, 2009 from the MedicineNet.com Web Site: http://www.medterms.com/script/main/art.asp?articlekey=2152.

2. McDowell, Ian and Newell, Claire. Measuring Health: A Guide to Rating Scales and Questionnaires, second edition. Oxford University Press, 1996.

3. The American Geriatrics Society Foundation for Health in Aging. (n.d.) Nursing Home Care. Retrieved June 16, 2009 from The American Geriatrics Society Foundation for Health in Aging Web Site: http://www.healthinaging.org/agingintheknow/chapters_print_ch_trial.asp?ch=15#Lives.

4. Gaugler, Joseph E, Duval, Sue, Anderson Keith A and Kane Robert L. (June 19, 2007). Predicting Nursing Home Admission in the U.S.: A Meta-Analysis. Retrieved June 15, 2009 from the PubMed Central Web Site: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1914346.

5. Bookman, Ann, Harrington, Mona, Pass, L, and Reisner, Elizabeth. Family Caregiver Handbook. Massachusetts Institute of Technology, 2007.

An Introduction to Diabetes: Types, Symptoms, Causes

An Introduction to Diabetes:
Types, Symptoms, Causes

Part 1 of a 5 part series

Diabetes mellitus, or diabetes, was recognized as a disease as early as 1500 B.C., when it was noticed that ants were attracted to the urine of people who had a disease that caused them to lose weight. By 1000 B.C., "water tasters" tasted the urine of people who were thought to have diabetes. If their urine tasted sweet, they were diagnosed with diabetes. The Latin word for honey, mellitus, was incorporated into the name, which became diabetes mellitus.

In the mid-1800s, researchers began to investigate digestion and diet as contributors to diabetes and special diets were prescribed. In 1908, Georg Zuelzer, a German scientist began injecting an extract from the pancreas to treat diabetes. Frederick Banting of Canada and Charles Best of the United States discovered insulin in 1921. By the 1940s, a connection between kidney and eye disease and diabetes had been determined. Over time, the purity of insulin was gradually improved, until synthetic insulin was introduced in 1983. Delivery of insulin was greatly improved with the development of pumps in the early 1990s. With greater control of insulin delivery, more precise management of blood glucose was possible.

Currently, 23.6 million people in the U. S., or 7.8% of the population, have diabetes. Although it is the seventh leading cause of death in the United States, nearly 6 million are unaware that they have diabetes. These individuals are at greater risk for heart disease, stroke, high blood pressure, blindness, kidney disease, and nerve damage, making both diagnosis and management critical. Read on to learn what you can do if you or someone close to you may have diabetes.

There are two main types of diabetes-type 1 or insulin-dependent diabetes, which used to be called juvenile diabetes, and type 2 diabetes, which tends to occur later in life. In type 1 diabetes, special cells in the pancreas stop making insulin, which is necessary for blood sugar or glucose to enter your cells. Because glucose doesn't enter the cells, it builds up in the blood. It is thought that the cells of the pancreas that make insulin are damaged by an immune reaction. In type 2 diabetes, the body makes insulin, but the body doesn't respond to it correctly. Again, glucose builds up in the blood.

A third type of diabetes occurs during pregnancy and is called gestational diabetes. About 1% to 3% of pregnant women develop gestational diabetes. Typically, it develops during the second trimester of pregnancy. Usually, it goes away after a woman gives birth. It is not known why women develop diabetes during pregnancy, but it seems to be due to hormones released during pregnancy that help the baby develop. These hormones interfere with the action of insulin in the mother's body. Infants born to women with gestational diabetes may weigh much more than average babies and may suffer from hypoglycemia (low blood sugar) or jaundice. These complications can generally be avoided with changes in diet and exercise as well as other recommendations prescribed by your doctor

The immediate cause of diabetes and its symptoms is the buildup of glucose in the blood. Your body makes glucose when you digest food. It is a necessary source of energy for all the cells of your body. Insulin is necessary for glucose to enter the cells. In diabetes, insulin doesn't work properly and glucose can't get into the cells. In type 1 diabetes, cells in the pancreas called the islets of Langerhans are damaged and stop making insulin. In type 2 diabetes, the pancreas makes insulin, but the cells of the body don't respond to it. In both cases, glucose builds up in your blood.

In the case of type 1 diabetes, it is believed the body's immune system attacks and kills the islets of Langerhans and they make little or no insulin. It isn't understood why the body becomes less sensitive to insulin in type 2 diabetes, but excess fat, especially abdominal fat, low HDL ("good "cholesterol), high triglycerides and a lack of exercise seem to be factors related to developing type 2 diabetes.

August 1: Diabetes: Complications

Diabetes: Complications

Part 2 of a 5 part series

Diabetes ComplicationsWhat are some Complications of Diabetes?

Untreated diabetes leads to very serious complications. If you have diabetes, it is very important that you follow your doctor's directions for controlling the amount of glucose in your blood. High levels of glucose in the blood can damage multiple organs of the body.

Heart Disease and Stroke

Having diabetes places you at twice the risk of heart disease and stroke.[8][9] Over time, high levels of blood glucose cause increased plaque or fatty deposits in blood vessel walls. This is often called atherosclerosis or hardening of the arteries. This increases the likelihood that blood clots will form causing either a heart attack or stroke.

Nerve Damage from Diabetes

Uncontrolled blood glucose can lead to nerve damage.[8][9] About 60% to 70% of people with diabetes have some nerve damage. Risk of nerve damage or neuropathy increases with age; typically, it occurs after 25 or more years after you get diabetes. Nerve damage results in symptoms such as pain, tingling, or numbness in hands, arms, feet and legs. There can also be nerve damage in the digestive tract, heart and sex organs.

Loss of feeling in the feet and legs and poor blood circulation can lead to infection and ultimately amputation. Always protect your feet by wearing slippers or shoes, even at home. Be sure to check your feet on a daily basis for problems. Wash them daily and be sure to dry them carefully, especially between the toes. Use lotion if the skin is dry but do not use lotion between your toes. Discuss extra steps you can take to protect your feet with your doctor.

Sexual Problems

Diabetes can lead to sexual problems. For men this involves erectile dysfunction or an inability to have or sustain an erection. For women, there can be difficulties with lubrication and painful intercourse. For both sexes, there may be issues with urinary tract infections and bladder control. Controlling blood glucose, blood pressure and cholesterol levels can help you avoid these problems. Stay active and manage your weight. If you are having problems, discuss them with your doctor.

Problems with Digestion

Diabetes can also affect the digestive tract resulting in delayed emptying of the stomach. This is due to damage to the nerves that control the stomach. Symptoms include heartburn, abdominal pain, nausea, vomiting of undigested food, a feeling of fullness after eating very little food, weight loss, bloating, lack of appetite and abdominal spasms.

You can avoid digestive tract problems by managing glucose levels and changing your diet. Talk with your doctor about dietary changes. He or she may recommend eating six small meals a day instead of three larger meals. You may also consider eating liquid or pureed food rather than solid food. You should avoid foods high in fat.

Kidney Damage from Diabetes

Kidney failure causes the kidneys to stop removing waste materials from your blood. Diabetes is the most common cause of kidney failure.[9] More than 100,000 people develop kidney failure each year in the United States and nearly 180,000 people are living with kidney failure at any given time.

When the kidneys no longer remove wastes from the blood, people must either have dialysis on a regular basis or have a transplant of a healthy kidney from a donor.[9][10] Dialysis involves having the blood filtered outside the body. Federal funds are available for this expensive process.

It takes several years to develop kidney failure-up to 15 to 25 years.[9] Initially, the kidneys of diabetics may work harder to cleanse the blood, but with time they stop working properly. As the kidneys begin to fail, a protein called albumin begins to leak into the urine. Gradually, the kidneys' ability to remove waste from the blood declines. Blood pressure often increases as waste builds up in the blood.

Eye Disease or Retinopathy from Diabetes

Diabetes is the single, largest cause of blindness in the United States.[10] Eye disease due to diabetes involves three things: damage to blood vessels in the retina, cataracts and glaucoma or increased pressure inside the eye.[11] In some people, damage to the blood vessels in the eyes causes the blood vessels to swell and leak. In others, abnormal, new blood vessels grow on the retina blocking vision. In the case of cataracts, the lenses of the eyes become clouded, which also interferes with vision. Glaucoma increases the fluid pressure inside the eye, which damages the optic nerve and impairs vision. Glaucoma is twice as likely in people with diabetes.

Early signs of vision problems include blurry vision and spots or floaters in your eyes.[11] Leakage from blood vessels is most likely to occur while you are sleeping. Enlarged blood vessels may block vision. If damage is occurring, it is likely to occur in both eyes. If you have any of these problems, see your doctor as soon as possible. Treatment of eye disease may involve laser surgery or vitrectomy to remove the fluid in the eye clouded by blood.

Because the risk of eye damage is so great among diabetics, it is important to see your doctor at least once a year for eye exams.[11] During the early stages of disease, it may not be clear that your vision is being affected. Only your doctor can tell for sure whether your vision is being damaged. The most important step you can take to avoid vision loss is to carefully control your blood glucose level. In addition, controlling blood pressure and cholesterol is important. Be sure to discuss these issues with your doctor.

Diabetes: Treatment

Diabetes: Treatment

Part 3 of a 5 part series

How do you Treat Diabetes?

For all types of diabetes, the focus of treatment is to manage blood glucose levels to avoid diabetic complications. Generally, the goal is to keep daytime glucose levels between 80 and 120 milligrams per deciliter (mg/dL) and bedtime levels between 100 and 140 mg/dL. Type 1 diabetes treatment involves the use of insulin, dietary controls, exercise and weight control.[12] If you have type 2 diabetes, your doctor is likely to see if you can control blood glucose levels through diet, exercise and weight control as a first step.[13] It may be necessary, however, to control glucose levels with medicine.

Type 1 Diabetes

The use of insulin is essential for control of type 1 diabetes.[12] There are numerous types of insulin ranging from rapid-acting to long-acting forms. Your doctor may recommend a mixture of these types of insulin. Insulin cannot be taken orally. Insulin may be injected instead using a needle and syringe or an insulin pump. An insulin pump is a small pump worn on the outside of the body that carefully injects rapid-acting insulin.

Other forms of medicine may be necessary including Pramlintide (Symlin), an injection taken before eating, low-dose aspirin to prevent heart disease, high blood pressure medicines and cholesterol-lowering statins.

With respect to diet, you will need to control caloric intake, avoid fatty foods and sweets and eat more fruits, vegetables, and whole grains. You will also need to learn to manage how much carbohydrates you eat. A dietitian can help you design a meal plan, plus you can find handy recipes in this article to help you manage sweets and calories.

Exercise is important, but check with your doctor before starting an exercise program to make sure you're healthy enough. Pick activities you enjoy when exercising. Be sure to make them a regular part of your daily activities. Try to exercise at least 30 minutes most days of the week. You will need to carefully monitor your glucose levels when you exercise.

Type 2 Diabetes

Typically, the first steps to treat type 2 diabetes involve diet, exercise and weight control.[13] If these steps are not adequate to control your blood sugar, then medicine will be necessary. One medicine may be enough; if not, you may need to take a combination of medicines. There are several medicines that can be taken orally in addition to injectable medicines. Drugs that can be taken orally include:

• Glipizide (Glucotrol). This medicine can cause low blood sugar and weight gain.

• Metformin (Fortamet, Glucophage and others). This medicine doesn't cause weight gain and may reduce LDL cholesterol (bad cholesterol) and triglycerides. It can cause diarrhea.

• Glimepiride (Amaryl). This can cause low blood sugar and weight gain.

• Rosiglitazone (Avandia). This drug may cause a slight increase in HDL cholesterol, the good cholesterol. It can cause swelling and weight gain and may lead to or worsen heart failure. It may increase LDL cholesterol and triglycerides and increase the risk of heart attack.

• Pioglitazone (Actos). This drug may decrease triglycerides and increase LDL cholesterol. It can cause swelling and weight gain. It may lead to or worsen heart failure.

• Sitagliptin phosphate (Januvia). This drug does not cause weight gain. It can cause upper respiratory tract infection, sore throat and diarrhea.

Injectable medicines for type 2 diabetes include:

• Pramlintide (Symlin). This medicine may promote weight loss. It cannot be taken with other diabetes medicines and may cause nausea.

• Exenatide (Byetta). This drug may promote weight loss. It can cause nausea.

October 1: Diabetes: Management

Diabetes: Management

Part 4 of a 5 part series

What are some Tips for Managing Diabetes?

There are many things you can do to manage diabetes.[14] Specifically, this means maintaining a safe level of glucose or blood sugar. Here are a few things you should watch on a daily basis to manage your diabetes:

• Food. Eating the right foods is one of the most important things you can do to manage your blood sugar levels. How much you eat and when you eat is important. Your blood sugar level is the highest an hour or two after you eat. Once you've determined what combinations work best for you, try to eat the same amount of food at the same time every day.

  Carbohydrates have a large impact on your blood sugar level. Eating the same amount of carbohydrates during meals and snacks will even out your blood sugar levels throughout the day.

  Managing how much food you eat and coordinating meals with your medicine is critical, especially if you take insulin. Taking medicine without enough food can cause dangerously low blood glucose levels. On the other hand, too much food can cause your glucose levels to be too high. Work with your doctor to find the right balance.

• Exercise. Regular, physical activity is an important part of the plan to manage your diabetes. Even light exercise like gardening or house work can be helpful. Exercise does several things. It improves your glucose levels. It also causes your body to be more sensitive to insulin, which helps you manage glucose. Finally, it can help you lose weight. If you use insulin, you may need to adjust your dose before exercising. Discuss this with your doctor.

• Medicine. The effectiveness of your medicine depends on when you take it and how much you take. Medicines you take for other conditions can impact your blood sugar level. Be sure to discuss all of your medicines with your doctor. If you are noticing problems with your blood sugar levels, talk with your doctor. You may need to adjust the amount of medicine you take or when you take it.

Recipes for Diabetics and Those at Risk for Diabetes

There are many free online sources for recipes for diabetics. Here are a few:

• Mayo Clinic
• National Diabetic Education Program
• Diabetic Gourmet Magazine
• Diabetic-Recipes.com
• iFood.tv
• dLife

These sources are organized by category and include recipes for desserts including cakes, cookies, candy and other snacks.

Here's a selection of recipes that you might enjoy.

• Sugar-free Chocolate Nut Clusters
• Tasty Diabetic Fudge
• Diabetic Pizza
• Diabetic Popcorn Balls
• Diabetic Chocolate Cheesecake
• Diabetic Crockpot Recipes

Diabetes: How Can We Prevent Diabetes?

Diabetes: How Can We Prevent Diabetes?

Part 5 of a 5 part series

There is no known method to prevent type 1 diabetes. This type of diabetes occurs when the body's own immune system attacks the insulin-producing cells of the pancreas. It is believed that genetic and environmental factors contribute to getting type 1 diabetes. Relatives of people with type 1 diabetes are at 10 to 20 times greater risk of developing the disease.

The number of people developing type 2 diabetes is increasing. If you are at risk of getting type 2 diabetes, there are things you can do to help prevent it. Risk factors for the disease include having a family history of type 2 diabetes and being overweight. Prevention focuses on losing weight and eating a healthy diet. Here are some steps you can take to avoid developing type 2 diabetes:

• Exercise. Exercise on a regular basis can help you lose weight. Even if you don't lose weight, exercise will improve glucose levels and increase your body's sensitivity to insulin.

• Eat lots of fiber. Increasing the amount of fiber in your diet can improve glucose levels. It can also reduce the risk of heart disease. Choose foods such as fruits, vegetables, beans, whole grains, nuts and seeds.

• Eat whole grains. Whole grains can reduce your risk of diabetes and improve blood sugar levels. At least half of the grains you eat should be whole grains.

• Maintain a healthy weight. Studies show that losing only 5 to 10% of excess weight can reduce your risk of developing diabetes.

• If you're overweight, get screened for diabetes on a regular basis after age 45. If your weight is normal, you're over 45, but you have risk factors for the disease such as lack of exercise or a family history of the disease, talk with your doctor about testing.

Stroke: Signs and Symptoms

Stroke: Signs and Symptoms

Part 1 of a 5 part series

Stroke is sometimes referred as "brain attack" and with good reason: Similar to a heart attack, a stroke occurs when the blood supply to the brain is blocked. And like a heart attack, the effects of stroke can range from mild to fatal, with a wide range of effect that leave a lasting impact both on the sufferer and his or her family. If someone you care about has had a stroke, you're probably curious to find out why it happened, what comes next, and what you can do to prevent it from occurring again. Follow the links here to find answers to these questions as well as advice for stroke caregivers.

What is a Stroke?

A stroke occurs when blood stops flowing to or inside the brain. This occurs either because in one of two ways. Either a blood clot stops flow in the brain or a blood vessel bursts and the part of the brain that that vessel supplied don't get fresh, oxygenated blood. The presence of leaking blood also kills brain cells. When a clot stops blood flow, it is called an ischemic stroke. This is the more common type of stroke. When a blood vessel breaks, it's called a hemorrhagic stroke. When a stroke is of short duration, it's called a transient ischemic attack or TIA.

Stroke is the third most common cause of death in the US and the leading cause of long-term disability. While the number of new cases of stroke has been decreasing over the last 50 years, the severity of stroke has not decreased. Currently, there are 750,000 new strokes each year in the United States.

What are the Effects of Stroke

The long-lasting effects of stroke depend on what part of the brain is affected and what functions that part of the brain has. You may feel weakness or paralysis on one side of the body. There may be numbness on this side as well. You may tire easily. There may also be stiffness and pain in your muscles; poor balance and/or coordination; and speech difficulties. In addition, you may have problems with thinking, memory and attention. There may be problems with swallowing and bowel or bladder control. You may also experience difficulty controlling your emotions or you may become depressed. Rehabilitation specialists can help you with many of these issues.

With respect to movement and mobility, because one side of the brain controls movement on the opposite side of the brain, stroke on one side often affects movement the opposite side. Also, some brain functions are localized and a stroke can affect specific functions depending on where it occurs. Here are some examples of what can happen.

Effects of Right Brain Stroke

If the right side of the brain is affected by stroke, the left side of the body will be paralyzed. Other effects can occur because of functions localized on the right side of the brain:

• Vision problems

• Behavioral changes resulting in a quick, inquisitive behavioral style

• Memory loss

Effects of Left Brain Stroke

If the left side of the brain is injured by a stroke, then the right side of the body is paralyzed. Other effects include:

• Speech and language problems

• Behavioral changes resulting in a slow, cautious behavioral style

• Memory loss

Stroke Prognosis

About 70% of people who have ischemic stroke regain their independence and 10% recover completely. About 25% of those who have had an ischemic stroke die. The outcome of a hemorrhagic stroke depends on what part of the brain it was located in. Generally, though, hemorrhagic stroke has a worse prognosis than ischemic stroke. Overall, 25% of stroke patients recover with minor impairment; 40% have moderate to severe impairment; and 10% require long-term care. Approximately, 14% of stroke victims will have another stroke within one year.

Stroke: Risks

Stroke: Risks

Part 2 of a 5 part series

There are several conditions that increase your chances of having a stroke.[9] Some of them you have control over, some you don't. The good news is you can do something about most of these risk factors. Here's a list of the things you have some control over:

Controllable Risk Factors

• High blood pressure. While you may not be able to avoid getting high blood pressure, you can take medicine to control it. In most cases, it's possible to bring blood pressure down to acceptable levels. A healthy diet and regular exercise can also lower blood pressure.

• Coronary heart disease. While you might not be able to completely control coronary heart disease, you can do some things to improve the condition. Limit the amount of cholesterol in your diet and talk with your doctor about taking baby aspirin on a daily basis.

• Diabetes. Controlling your blood glucose levels along with controlling cholesterol and blood pressure can lower your risk for stroke.[10]

• Atrial fibrillation. This is a problem in which the upper part of the heart beats too rapidly and too weakly. This can cause blot clots to form in the heart and travel to the brain. Atrial fibrillation can be treated with medicine, pacemakers and surgery.[11]

• Tobacco use. If you smoke, you should do your best to stop. It is the source of numerous diseases as well as stroke.

• High cholesterol. This increases your likelihood of having a blood clot and increases the risk of stroke. Control the amount of cholesterol in your diet and exercise regularly. Take a statin if diet isn't enough to bring your LDL cholesterol down to an acceptable level.

• Excessive alcohol use. Excessive alcohol use can increase your blood pressure. Limit the amount of alcohol—no more than one drink a day for women or 2 drinks a day for men.

Uncontrollable Risks for Stroke

There are some risks that you won't be able to do anything about, but it's important for you to know about them. If you have any of these risks, be sure to discuss them with your doctor.

• Genetics. Risk for stroke runs in families. If this is true of your family, be sure to discuss this with your doctor.

• Age. The risk of having a stroke doubles for each 10 years of life after age 55.[12]

• Gender. Men have a 25% greater risk for stroke than women.[13] The reason for this is not known.

You can take a self-assessment for your risk of stroke online by going to http://www.memorialcare.org/medical_services/stroke/stroke-risk-awarenes... .

This assessment does not take the place of your doctor's evaluation or advice. If you think you are at risk, discuss it with your doctor.

Stroke: Causes

Stroke: Causes

Part 3 of a 5 part series

What are the Causes of Stroke

The causes of stroke vary depending on the type of stroke—ischemic or hemorrhagic stroke. Ischemic stroke involves blockage of a blood vessel in the brain and brain cells die as a consequence. Hemorrhagic stroke occurs when a blood vessel breaks in the brain. The presence of blood causes brain cells to die. Here are specific reasons for why these events happen:[14]

Causes of Ischemic Stroke

• Thrombotic stroke. This type of stroke occurs when a clot forms in one of the arteries that supply blood to the brain. This is the result of atherosclerosis or hardening of the arteries.

• Embolic stroke. This type of stroke occurs when a clot forms somewhere other than the brain. If the clot breaks loose, it can travel to the brain and block an artery there. Typically, the clot comes from the heart during atrial fibrillation when the upper chambers of the heart beat irregularly.

TIAs are typically due to clots blocking blood flow in the brain. TIAs are brief, but they indicate there is a problem with blood vessel in the brain that may cause a problem again later. If you've had a TIA, you are more likely to have a full-blown stroke.

Causes of Hemorrhagic Stroke

• Intracerebral hemorrhage. This type of stroke occurs inside the brain and is usually due to high blood pressure. High blood pressure causes blood vessels to be brittle and break easily.

• Subarachnoid hemorrhage. In this type of stroke, bleeding occurs in an artery in or near the surface of the brain. Blood enters into the space between your brain and your skull. It causes a sudden and severe headache. The leaking blood causes other blood vessels to act erratically resulting in less blood in other areas of the brain and further damage. Typically, this type of stroke is caused by a burst aneurysm, which is a ballooning section of a blood vessel caused by weakness in the wall of the vessel.

Stroke Due to Vasculitis

Vasculitis can cause stroke. Vasculitis is an inflammation of blood vessels due to autoimmune diseases of connective tissues such as rheumatoid arthritis or lupus. The inflammation can cause a reduction in blood flow. It can also cause blood to leak. The condition can cause strokes.

Coming March 1: Stroke: Treatment

Stroke: Treatment

Part 4 of a 5 part series

Don't attempt to treat yourself with aspirin because you could make a hemorrhagic stroke worse. Only your doctor can determine what type of stroke you have had.

We will be adding more articles from Emeritus every month.
Be sure to bookmark this page and check frequently.