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There can be many reasons why you might want to change your primary care physician. For Medicare beneficiaries, especially, understanding when and how to make the switch is key to maintaining continuous, high-quality care. Below, we walk through: How to switch Medicare primary care doctors How often can you change your primary care physician And when it comes to other people like you, how often do patients change doctors Why do people change primary care doctors? Changing primary care doctors is more common than you might think. According to one survey, around 4 out of 10 patients switch care providers over time. The more frequent reasons include: Your health needs have changed Aging changes your body in many, and often surprising, ways. There are new aches and pains, new chronic conditions, and existing health conditions may grow worse. Because of this, you might need a doctor who is more knowledgeable and experienced in treating your new conditions, or is a specialist in your pre-existing chronic disease. Many senior adults might also switch to a geriatrician. These are doctors who specialize in procedures, practices, and treatments that serve the very specific needs of older adults. Read more: What is geriatric care and why is it important Your Medicare plan has changed Shake-ups in healthcare plans, especially in Medicare Advantage (also known as Part C and provided by private insurance companies) are commonplace. Care providers may decide not to renew contracts with insurance providers, which means they will no longer accept your insurance. In such a case, you would have to choose between switching doctors, or switching your healthcare plan. What you should know about Medicare Advantage Open Enrollment Period You’ve moved Moving to a new area, say from Arizona to Texas, would make it necessary to find a more accessible doctor, within a reasonable distance from your new home. Your current doctor has retired Sometimes it’s not a patient’s choice, but a necessity if your doctor is the one stepping away. Doctors may change workplaces, move away, or retire. In this case, you must find a new provider, whether you are ready for the switch or not. It’s just not working out If you have started seeing a new doctor recently, you’re probably still in the process of evaluating them. Are you happy with the way they communicate? Do you feel heard? Do you have confidence in the doctor’s ability to provide satisfactory care? Are you comfortable with the wait times at the clinic? Ideally, you want a doctor you can keep seeing for as long as possible, because a long and satisfactory patient-provider relationship makes a strong foundation for good continuity of care. Some patients can figure out if they click with their doctor or not during their very first appointment. Others might need a few more visits. Either way, both have the freedom to continue meeting new physicians until they are satisfied. Worried about making the switch? Some common concerns You may be apprehensive about changing your care provider, especially if you’ve been seeing them for a long time. You may worry you will ‘upset’ your doctor, or that it’s rude, or that you’re doubting their capabilities. These feelings are common. However, your own health and comfort are the priority here, and a good doctor should understand that. If your current doctor gets upset that you don’t want to see them anymore, that’s a red flag, because responsible care professionals understand that patients’ needs evolve, and your decision to switch is about your well-being, not a personal affront to them. Do I have to give reasons or explanations for switching doctors? If you feel you must explain your decision to soothe your doctor’s hurt feelings, then no. There is no need to do that. On the other hand, your current doctor may be able to help with suggestions and recommendations if they know why you’re switching. For instance, if your COPD is worsening, they may guide you toward another doctor who is more experienced in the treatment and care of the disease. Learn more: What is Chronic Obstructive Pulmonary Disease (COPD) Can my current care provider cause any problems if I move to another doctor? Some senior patients worry that their current care provider may not transfer their health records to the new provider, but HIPAA gives you the right to transfer your medical records. Under the Health Insurance Portability and Accountability Act (HIPAA), you have the lawful right to access and transfer your medical records whenever you want, to whichever care provider you want. Transferring medical records to a new physician is necessary to ensure continuity of care. As a standard procedure, your records are usually transferred to your new doctor within 30 days of requesting them. Brush up on Your rights as a patient How often can you change your primary care physician? You can switch doctors as often as you need to, or whenever you want to. On Original Medicare: You can see any doctor who accepts assignment. There’s no need to notify anyone when switching. On Medicare Advantage: You can only see doctors in your plan’s network. Before switching, check your plan’s provider directory or contact your insurer, or you may have to deal with high out-of-pocket costs. You may also need to update your PCP selection with the plan. What’s the downside of switching doctors too often? Even though there’s no limit to how often you can switch doctors, it’s not advisable. Seeing the same doctor for long helps establish good continuity of care. Frequent switches can make it harder for any doctor to get a full picture of your health history, whereas having one provider who really knows your medical history is one of the best ways to catch problems early and manage chronic illness better. Step-by-step: How to change your Medicare primary care doctor Changing doctors is a serious decision because establishing trust with a new care provider may take time. Here are the 10 steps, in sequence, to help you

The difference between PCP and internal medicine might seem small, but for senior adults enrolled in Original Medicare or Medicare Advantage plans, it can sometimes mean the difference between routine care and specialized support. What’s the difference between internal medicine and primary care? Both a PCP and an internist can manage your regular healthcare needs. But they come from slightly different medical backgrounds and focus on different things. Primary care vs internal medicine at a glance Feature Primary Care Doctor (PCP) Internal Medicine Doctor Treats adults Yes Yes Treats children Yes (if trained in family medicine) No Focuses on geriatric care Often Yes Treats complex conditions Yes Yes Provides preventative care Yes Yes Manages hospital care Sometimes Always Coordinates care Yes Yes Find a PCP in Arizona or Texas Most internists are PCPs, but not every PCP is an internist because, as you can see from the table, some PCPs specialize in treating children. At IntraCare Health Centers, we discuss the choice in detail with our senior adult patients and/or their caregivers, to help them determine which kind of care provider would best suit the patient’s needs. Read more: How to find a doctor in your area you can trust Do you need a PCP or an internist? If you’re 65 years of age or older and managing one more multiple chronic conditions, choosing the right type of doctor may help you stay healthier, reduce the frequency of hospital visits, and allow you to make the most of your Medicare plan. Let’s walk through the real distinctions between a primary care physician or primary care provider (PCP) and an internal medicine doctor (internist), and learn how to decide which one best suits your needs. Primary care physicians (PCP) A primary care physician is generally every person’s main point of contact for nearly all healthcare needs that aren’t urgent or life-threatening. PCPs provide a number of services to patients of all ages, from children to adults. For senior adults, the services of a PCP may include: Performing check-ups and Medicare-recommended health screenings Managing long-term conditions like high blood pressure, diabetes, arthritis, and heart disease Treating short-term illnesses like infections Cleaning, treating, and dressing minor injuries Performing necessary vaccinations Coordinating specialist referrals Tracking your medications and health goals Conducting Medicare Annual Wellness Visits PCPs may be trained in family medicine, internal medicine, or even geriatric care. Read more: 5 immunizations you should get after age 65 Internal medicine doctor (internist) Internal medicine doctors are called that because their area of expertise is the internal organs and their care. Internal medicine doctors focus on adult medicine, and their patients are typically aged 18 years and up. But they’re especially valued for treating older, senior adults with complex, chronic conditions. Internists: Provide all or many of the same services that PCPs do Are trained to handle multiple co-existing illnesses and health problems Often coordinate care during hospital stays Specialize in the prevention, diagnosis, and treatment of diseases in adults Typically do not treat children or pregnant women Remember: Doctors of internal medicine are usually PCPs, but not all PCPs are internists Is an intern and internist the same thing? No. Interns are recent medical school graduates in their first year of residency training. They cannot practice unsupervised. Internists are qualified physicians who have completed their residency training. They are licensed to practice medicine and may be board-certified. Read more: 6 signs of a good doctor When to choose a PCP A universal primary care doctor may be ideal if you: Are mostly healthy and want someone to monitor your wellness from year to year Need guidance on Medicare-covered preventive screenings Want to continue with a provider you’ve been seeing for years already, long before you turned 65 Want help managing one or two chronic conditions, like high cholesterol or early-stage diabetes Related read: What to expect at your FREE Medicare Annual Wellness Visit When to choose an internist Consider choosing an internal medicine doctor if you: Have multiple chronic illnesses, such as diabetes, congestive heart failure, and COPD Are taking several medications that need careful coordination Have had recent hospital stays and need follow-up care Want a provider with deep expertise in managing complex adult health problems Read more: What does the label on your bottle of prescription medication mean? Why this choice matters more as you age As we get older, our bodies don’t bounce back from illnesses, diseases, and viruses like they used to. Medications can interact differently with each other, or with supplements, or with certain foods. Illnesses show up in unexpected ways. And we’re more likely to have overlapping conditions that affect each other. Choosing the right type of doctor means: Your healthcare is better coordinated across multiple care providers You are at lower risk of hospitalization Any illnesses, current or potential, stand a better chance of being properly diagnosed You are able to manage medications more effectively You get personalized care plans based on your age, goals, and Medicare plan Useful read: Brush up on the best vitamins for seniors over 65 How Medicare covers PCPs vs internists Original Medicare (the standard government plan, also known as Part A and Part B) considers both PCPs and internists eligible for coverage as long as they are properly credentialed and accept assignment. Most Medicare Advantage (also known as Part C, and usually provided by private health insurance companies) plans do not differentiate between PCPs and internists either. All you need to do is make sure your provider is included in your healthcare plan’s coverage network. What is covered under Original Medicare and Medicare Advantage plans Whether you are seeing a primary care physician or internal medicine doctor, you will likely be covered for: Medicare Annual Wellness Visits Chronic care management Preventative screenings for diabetes, breast cancer, prostate cancer Medicare reviews Referrals to specialist consultants Coordinated care Read more: Understanding Medicare Enrollment periods, renewals, and re-enrollment The IntraCare difference: Coordinated, compassionate care At IntraCare, we place a lot of emphasis on

Wondering if your primary care doctor can help manage your diabetes? For seniors in Texas and Arizona, they may be your best long-term partner in care. Learn how PCPs support diabetes treatment and how Medicare covers key services. How PCPs help manage diabetes If you’re asking, “Can a primary care doctor treat diabetes?”, the answer is yes. Primary care providers can definitely help with the treatment and management of diabetes mellitus, also known as type 2 diabetes. In fact, for senior adults aged 65 years and above, especially those enrolled in Original Medicare or Medicare Advantage plans, your primary care doctor is often the best person to help manage your diabetes. Why? Because a good primary care provider offers continuous, personalized care, helps you navigate Medicare-covered services, and coordinates with specialists when needed. In other words, they’re your quarterback in the game of long-term health. Let’s walk through why your primary care provider, or PCP, is fully equipped to help you manage diabetes, and how you can make the most of that relationship. Click here to find diabetes doctors in Arizona What is diabetes management? Before we dive into the role of your primary care doctor, let’s talk about what managing diabetes really means. At present, around 1 in 8 Americans has diabetes. When looking at people aged 65 and above, the number jumps to 1 in 4. As a result, diabetes is the eighth leading cause of death in the US Whether you’ve been diagnosed with type 2 diabetes, type 1 diabetes, or prediabetes, ongoing management of the chronic condition is essential. That includes: Regular blood sugar monitoring Lifestyle changes like diet and exercise Medications or insulin therapy Routine screenings for complications (eye exams, foot checks, kidney function tests) Managing other chronic conditions like high blood pressure or cholesterol That’s a lot of things to keep track of, but for convenient, consistent care, your PCP may be your best long-term partner in managing diabetes. Click here to find diabetes doctors in Texas How PCPs help manage diabetes Your primary care provider spent years in medical school training in internal medicine or family medicine, both of which include chronic disease management. For most senior adults with type 2 diabetes, which is the most common form of this chronic illness, primary care is often all you need for effective, long-term management. Your primary care provider is likely qualified and trained to: Diagnose diabetes based on lab results Start you on medications like metformin Order A1C tests, cholesterol checks, and kidney function tests Help you set realistic goals for blood sugar, diet, and activity Screen for complications like neuropathy or retinopathy If you’re stable and your numbers are good, you may never need an endocrinology specialist. But if things get more complicated, your primary care physician can bring in reinforcements. What is an A1C test?An A1C test, also known as a hemoglobin A1C (HbA1C) test, is a blood test that measures your average blood sugar levels over a period of two to three months. It helps to determine if you have diabetes or are prediabetic. If you are already diagnosed with diabetes, the test can help identify if you’re successfully controlling your blood sugar levels. How to read A1C levels – Below 5.7 — Normal – 5.7-6.4 — Prediabetes – 6.5 or higher — Diabetes When do you need an endocrinologist? Most people with type 2 diabetes can go years, or even forever, without needing an endocrinologist. But your primary care physician might want to refer you to an endocrinologist if you have: Difficulty controlling blood sugar despite taking meds regularly and according to doctor’s instructions Frequent episodes of hypoglycemia, or low blood sugar Complications affecting your eyes, nerves, or kidneys Even when an endocrinologist takes charge of your diabetes care, your primary care provider stays in the loop, kind of like a project manager for your health, making sure all the pieces of your healthcare fit together. Diabetes management for seniors: Why primary care matters more than ever As we age, managing diabetes becomes more complex. You may also be simultaneously juggling other health conditions like arthritis, high blood pressure, or heart disease. Your primary care physician is uniquely qualified to see the big picture. In fact, studies show that people with diabetes who regularly see a primary care doctor have better blood sugar control and fewer complications over time. Senior adults may benefit even more, because as your long-term care provider, your doctor: Knows how diabetes interacts with age-related health issues Will tailor your treatment goals based on your age, lifestyle, and other conditions Will monitor for medication side effects and drug interactions Will help you avoid unnecessary referrals, tests, or hospital visits Helpful read: What happens if you don’t pay a hospital bill Medicare and diabetes: What’s covered Here’s where things get really practical. Both Original Medicare (Parts A and B) and Medicare Advantage (Part C) plans cover a wide range of diabetes-related services. Your primary care doctor is your main point of contact to help you access them. Here’s what’s typically covered, and how your physician fits in: Service What it does How your PCP helps Medicare Annual Wellness Visit Reviews your health status and risks Creates a personalized preventative care plan Diabetes screenings Detects prediabetes or undiagnosed diabetes Orders blood sugar and A1C tests Medical Nutrition Therapy (MNT) Personalized counseling from a registered dietitian Refers you for covered sessions Diabetes Self-Management Training (DSMT) Education on meal planning, activity, monitoring Orders DSMT and monitors your progress Foot exams Checks for nerve damage or ulcers Performs basic exams, refers to podiatrist if needed Eye exams Screens for diabetic retinopathy Refers to ophthalmologist and follows up Therapeutic shoes Help prevent ulcers and foot damage Certifies medical need for footwear Lifestyle support from your PCP Lifestyle changes are easier said than done, especially when mobility is an issue or cooking healthy meals feels like a chore. But your doctor won’t just hand you a pamphlet and send you on your

French artist Claude Monet is famous for his ‘Water Lilies’. Painted between 1897 and 1926, the 250 artworks of a lily pond in his garden are admired even today for their atmosphere, colors, and brush strokes. At first, Monet painted the lilies in airy shades of blue, green, and purple. But midway through the series, he swapped his color palette for smoldering reds and muddy browns. “Eh?” went the perplexed critics. What was this? This was, quite simply, cataracts in Monet’s eyes, which changed the way he saw things. After having surgery at the age of 83 to remove the cataracts, Monet went back to painting in pinks and greens. What are cataracts Behind the pupil (the little black dot in the center of the eye) is a clear lens that directs light toward the retina to create the images we see. The transparent lens is made up of protein cells. Over time, these proteins break down and clump together to create a cloudy patch on the lens. This cloudy patch is the cataract. Cataracts usually start out as a grayish or milky white spot. The spot grows larger with time, and in more advanced stages the color of the cataracts can turn yellow or even brown. Comparison of an eye with a cataract and a normal eye What causes cataracts The main cause of cataracts among senior adults is the natural process of growing older. Statistics to pinpoint what percentage of people get cataracts show that 1 in 5 senior adults aged 65 years has cataract in one or both eyes. By the age of 75 years, this number rises to 1 in 2 adults. Cataracts may also be caused by: Diabetes: Persons with diabetes are at higher risk of developing cataracts. According to the CDC, 1 in 3 patients diagnosed with type 2 diabetes has cataracts. Medications: Occasionally, cataracts may form because of certain medications, such as statins to lower cholesterol, antiarrhythmics to treat an irregular heartbeat, medications that treat gout by reducing uric acid in the blood and kidneys, and corticosteroids used to manage allergies. Smoking: The thousands of chemicals in cigarettes, many of them highly toxic, create oxidative stress that speeds up the formation of cataracts. Injuries: Injuries that puncture the eye, as well as blunt injuries like getting hit in the eye with a ball, or a punch in a fistfight, can cause cataracts. Regular over-exposure to the sun also puts your eyes at risk. How do you know if you have cataracts Cataracts often develop gradually, and many people don’t notice them in the earlier stages. One of the most common warning signs of age-related cataract is fuzzy, blurred vision where it feels like you’re looking out through a dirty window. This happens because the milky, foggy patch in the lens affects the way light passes through. At thinner parts of the cloud, some amount of light may just be able to go through. Thicker, more opaque areas will stop any light from going through at all. The unevenness of light entering your eyes distorts and blurs the image being created on your retina. Other signs of cataract include: Colors look faded and washed out: Each of our eyes contains approximately 6 million color receptors called cones. These cones identify colors in brightly lit environments. Because the light coming to the cones is patchy and uneven after passing through the cloud on the lens, the cones cannot detect colors properly. Everything is yellow: Violet, blue, and indigo colors have very short wavelengths. When light hits the cataract, the cloudy patch absorbs these short wavelengths. The only colors that manage to get past the cloud are the ones with longer wavelengths: red, orange, yellow, and some green. This explains why Monet’s cataracts completely changed his art. The lilies he painted were still purple and pink in real life, but he could see them only as blobs of yellow and brown. Driving at night unnerves you: The opacity of the cataract and the generally low levels of light at night combine to make it very difficult to see well in the post-sunset hours. Even though there are approximately 120 million light receptors called rods in each eye, they can’t do their job because the cataract blocks what faint light may be available. This may make driving at night especially stressful and dangerous. Bright light makes your eyes hurt: The lens in our eyes is designed to collect light and direct it toward one single point on the retina. But because of the cloudy cataract, the light doesn’t collect. Instead, it scatters all through the eyeball, putting strain on the eyes. The brighter the light flooding into the eyes, the more sensitive your eyes grow, and the more they hurt. Seeing a ring or halo around a light: Light scattering all over the eye may cause you to see a halo or ring around light sources such as streetlamps and vehicle lights. Seeing double: Since the clouded lens stops light from gathering at one single point on the retina, the image you see may be replicated, either side by side or above and below. This may cause headaches, dizziness, and nausea. You give up hobbies: People with cataracts need more light to perform activities that require close-up vision. But because brighter light hurts your eyes, reading, sewing, or crafting can become more difficult, frustrating, tiring, and you may give them up without really knowing why. Cataracts vs glaucoma Although both reduce your ability to see, cataract and glaucoma are two distinct eye problems. Cataract is when the lens in the eye develops a cloudy patch. Glaucoma happens when the optic nerve of the eye is damaged. Your eyes produce a clear liquid called aqueous humor to keep the eyeball inflated at a steady pressure. Fresh aqueous humor pushes older liquid through drainage canals. If the older aqueous humor does not drain properly, the amount of liquid builds up and puts pressure on the eye system, including

“It’s on the tip of my tongue!” You throw your hands up in frustration. You know the word you want to say, you know what it means and what it looks like, yet somehow you just can’t pluck it from your brain and actually say it. Or, you find it a struggle to speak, suddenly start dropping words like ‘a’ or ‘the’, and your sentences shrink so much that instead of saying, “I’ll have a cup of coffee,” you gather every last ounce of strength to laboriously gasp, “I coffee!” These are just two examples of aphasia, a language disorder that makes it hard to communicate clearly, whether through speech or writing. What is aphasia Aphasia is a language disorder that leaves the affected person unable to properly understand, speak, read, or write. Since 1836, when the theory of ‘language centers’ existing in the left side of the brain was first put forth, studies have consistently confirmed that it is indeed the brain’s left hemisphere that allows us to process, express, and comprehend communication. Aphasia occurs when these language centers on the left side of the brain are damaged in any way. Research shows that the risk of aphasia increases with age, and 1 in 3 people aged 85 years and above are likely to develop aphasia. Types of aphasia There are 3 types of aphasia. Receptive aphasia, also known as fluent aphasia Expressive aphasia, or non-fluent aphasia Global, also known as total, aphasia   Receptive aphasia Receptive aphasia, also called Wernicke’s aphasia after German neurologist Carl Wernicke, means having trouble understanding messages received from other people. It happens when the Wernicke’s area, a section of the brain a little ways above and slightly behind the left ear, is damaged. The reason receptive aphasia is called fluent aphasia is that although affected persons are not able to fully comprehend received messages, they can usually still talk ‘well’, even effortlessly, at a normal speed and rhythm. However, while they may chatter easily and be grammatically correct, it is quite possible that what the person is saying makes no sense. They may frequently use wrong words, or use made-up words that have no actual meaning. Expressive aphasia Expressive aphasia refers to having trouble getting your message across to other people. It is called Broca’s aphasia in a nod to French surgeon and neurologist Pierre Paul Broca. The Broca’s area in the brain is located in the left temple, midway between the eye and ear.   Image caption: The Broca’s area and Wernicke’s area as located in the brain People with expressive aphasia can understand received messages well, but they tend to chop up their own speech and drop words. They may also physically struggle to shape, sound out, and speak words. They can read fairly well, but have trouble with writing. This is why expressive, or Broca’s, aphasia is also called non-fluent aphasia. Global aphasia This is the severest, most debilitating form of aphasia. Affected people lose a substantial amount of their language abilities and have trouble in both expressing as well as receiving communication. Also called total aphasia, global aphasia indicates that large sections of the left brain, including and surrounding the Wernicke’s and Broca’s areas, have been damaged. What causes aphasia Aphasia is caused in 2 ways. Sudden onset aphasia happens abruptly and without prior warning. This is the most frequently occurring form of aphasia, and is most commonly caused by stroke. Other reasons for sudden onset aphasia may be trauma to the head and brain because of injury, surgery, a tumor, hemorrhage, or an infection in the brain tissue. Gradual aphasia, also known as primary progressive aphasia (PPA), is a slow loss of language comprehension skills. It usually happens when a neurodegenerative disease like Alzheimer’s begins to damage brain cells. Unlike sudden onset aphasia which can be traced directly to stroke or trauma, gradual aphasia is more challenging to identify, and may be misdiagnosed or undiagnosed in the early stages. Primary progressive aphasia may be misdiagnosed as stress, normal aging, mood swings, or some form of cognitive decline. Dysarthria vs aphasia vs aphagia Aphasia is when you can’t remember the correct word for something, even though you know exactly what the object is, and can mentally visualize it. Or, you can no longer put together a coherent sentence. It is caused by damage to certain parts of the brain and is classified as a neurological language disorder. Dysarthria is a physical inability to talk. Dysarthria happens when you have trouble speaking because the muscles in the face, lips, tongue, throat, and respiratory system don’t work properly. Dysarthria is a neurological motor control disorder, not a language disorder. Aphagia is when you can’t swallow, or refuse to swallow, because of damage to muscles and nerves that control the act of swallowing. Aphagia may be caused by stroke, brain injury, and cancer treatments like radiation or chemotherapy. Aphagia is not a language disorder. What are the symptoms of aphasia Some aphasia symptoms may be specific to either receptive or expressive aphasia. Collectively, aphasia symptoms may include: Anomia, or forgetting naming words: Very often, this is the first and foremost symptom of expressive, or non-fluent aphasia. You are not able to say the name of an object, even if you can mentally visualize it as a picture, or as letters spelling it out. For example, you can picture a fork. You can see it neatly spelled out in your mind, in large block letters. But out loud, you say, “food-eat thing.” Telegraphing, or omitting: This is another common symptom of Broca’s aphasia. You leave out, or omit, several words from your speech and/or writing. The result is choppy, fragmented sentences which may not be easily understood by others. The symptom is called ‘telegraphic’ because it resembles the writing style used when sending telegrams. People tried to keep telegram messages as short as possible because extra words cost more money. Trouble with telephones, TVs, and radios: People with receptive aphasia may become

ADHD in senior adults Attention deficit hyperactive disorder, or ADHD, is known more as a condition affecting children, probably because it is often diagnosed in childhood. But children grow to become adults, and in 90% of cases the disorder grows right along with them. As a result, ADHD is now considerably prevalent among older adults as well, with 1 in 16 senior adults having been diagnosed with ADHD. What doctor can diagnose ADHD You might wonder what kind of doctor do you go to for ADHD diagnosis as an adult. Usually, primary care doctors are able to diagnose ADHD since they follow their patient’s health over the long term, and keep a close eye on anything that may seem out of the ordinary, or different from usual. Your primary care provider may then decide to refer you to a specialist in neurodevelopmental disorders for a more detailed examination. What is ADHD ADHD is a neurodevelopmental disorder. This means it is a condition that occurs when the brain, the spinal cord, and the complex network of nerves in the human body are still growing, forming, and developing. It helps to think of it as knitting a sweater. You start off alright, but somewhere in the process, the yarn frays, or gets tangled or knotted. You continue knitting with the frayed yarn, or without sorting out the tangles and knots, and produce a completely serviceable sweater. You can wear it just fine and it will keep you warm, but there will be lumps and bumps that won’t sit flat, or the pattern might turn out wonky. In the same way, any snags that happen during the development of the nervous system may show up as disorders like ADHD, Tourette’s Syndrome, Autism Spectrum Disorder, and learning disabilities such as dyslexia. Dopamine and norepinephrine deficiency in ADHD Neurons are nerve cells that send messages and instructions from the brain to various parts of the body, and vice versa. These messages and instructions are in the form of chemical molecules called neurotransmitters. There are hundreds of neurotransmitters in the human body, 2 of which are dopamine and norepinephrine. Our brains produce dopamine when we do something fun. Dopamine makes you feel happy, motivated, alert, and focused. Norepinephrine helps you perform ‘executive functions’ or mental processes such as paying attention, being aware, and controlling impulses and emotions, The symptoms of ADHD are stronger in people who do not produce enough dopamine and norepinephrine. Symptoms of ADHD in adults In children, ADHD usually shows up as hyperactivity, short attention spans, and impulsive behavior. These same symptoms show up in adults as well, and can be identified as: Work and career struggles Adults with ADHD have a tough time managing priorities and deadlines. You may struggle to focus on the task at hand, be easily distracted, lose track of time, and forget meetings and appointments. You are also more likely to job-hop or get fired. Relationship difficulties People with ADHD may be prone to impulsive, emotional outbursts. Others may call you ‘high strung’, easily frustrated, and quick to anger. You may jump into relationships too quickly, only to lose interest just as fast. Poor communication You might have a tendency to zone out when someone is talking to you, which makes you appear disinterested. Zoning out may also cause you to miss important information. You might talk excessively, frequently interrupt others, and not let others finish talking. Disorganization and impulsiveness Problems with planning, organizing, and prioritizing can spill into your personal life as well. You may walk off in the middle of folding laundry and not put it away for days. Or, on a sudden impulse you could decide to clean the entire house from top to bottom, lose interest after a few minutes, and leave your cleaning supplies in the middle of the living room as a hazard to trip over later. Feeling unmotivated We all have things we don’t want to do, but they must be done. Generally, we grit our teeth and get on with it. But when people with ADHD are faced with a task they find unpleasant, boring, or overwhelming, they often struggle to begin and tend to keep putting it off. Emotional and mental health challenges Being told repeatedly that you’re irresponsible, unreliable, disorganized, or lazy can wreak havoc on your sense of self. How is ADHD treated ADHD is not a curable health condition, but it can be very successfully managed with prescription medication, therapy, counselling, or a combination of these. Medications for ADHD When your primary care doctors diagnose ADHD and start you on a treatment plan, they will most likely prescribe medications that are categorized as either stimulants or non-stimulants. You might wonder, “Aren’t I already overstimulated?” It’s a common question among people with ADHD. In ADHD medications, stimulants are drugs that encourage the production of dopamine. Meanwhile, non-stimulant drugs target nerve cells in the brainstem near the spinal cord, that produce norepinephrine. During an ADHD screening, your doctor will perform a thorough evaluation of your symptoms, and may also speak with your family and/or friends, to determine the best course of treatment for you. From the information gathered, your care provider will determine whether to prescribe a stimulant to increase dopamine production, or a non-stimulant to increase norepinephrine levels. It may take some trial and error before you and your doctor settle on the right drug and dosage levels that work for you. How important is medication adherence in treating ADHD As it is for every health condition, making a medication schedule and sticking to it is of utmost importance to successfully bring ADHD under control. This is because you need to maintain a consistent and stable quantity of the drug’s active ingredients in your body. Miscalculating a dose, skipping a dose, or accidentally doubling a dose will affect the amount of dopamine and/or norepinephrine in your system. The levels of the chemical neurotransmitters can spike or dip, and it may take a while to bring them

Here’s a question that often comes up in conversations between senior adults: Can you have two primary care doctors with Medicare? The answer is yes, you can have 2 primary care physicians if you are enrolled in a Medicare plan. Medicare doesn’t stop you from having 2 primary care doctors at the same time. But whether or not that’s the best idea depends on several factors. What is a primary care physician A primary care physician is also known as a primary care doctor, or a primary care provider. They provide fundamental, essential — in other words, primary — healthcare. They’re typically the first point of contact for routine checkups, vaccinations, chronic condition management, and Medicare Annual Wellness Visits. A good primary care doctor will also maintain a thorough record of your health. This is crucial in coordinating care if you also see one or more specialist care providers, such as a podiatrist who helps you manage complications in the feet and legs brought on by diabetes. Ideally, you should have a long-term association with your primary care doctor. When your primary care physician has solid knowledge of your unique health history, individual care needs, and lifestyle, this can help lay a strong foundation for reliable continuity of care. What is the main reason for having two primary care doctors Generally, once you’ve found a doctor you can trust, one primary care physician is enough for most people. But in some cases, you might need more than one primary care provider. The most common reason for this is if you split your time between two homes in two different cities or states. How can I find a good doctor near me When searching for a primary care physician, you always want the best primary care doctor near you. Start with a simple web search. Typing “good doctors near me” in the search bar will give you a list all the physicians in your vicinity. From that list, pick a care provider who meets your requirements. As a senior adult aged 65 years or above, you would be looking for a doctor who specializes in Internal Medicine, Family Medicine, or Geriatric Care. Read all patient reviews and testimonials you can find for your potential care provider, and count their CAHPS stars. What are CAHPS stars The Centers for Medicare and Medicaid Services (CMS) have detailed databases of healthcare providers, hospitals, home and hospice care providers, and other care services affiliated with Medicare. CMS regularly conducts Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to determine patient experience and quality of care provided. Using this information, all licensed care providers are given stars. The more stars a doctor has, the higher they rank on the performance scale. You can search for your doctor and check their star rating using this tool on Medicare’s website. Found a good one! When you find a care provider who has the requisite qualifications, you can call their clinic and set up an appointment. At the appointment, pay attention to whether the doctor: – Listens and gives you plenty of time to talk about your health concerns without rushing you – Asks open-ended questions – Is non-judgmental – Prioritizes preventative care Here, in more detail, are the 6 signs you should look for when choosing a primary care provider. Can you have two primary care doctors with Medicare This depends on what kind of healthcare plan you have. Original Medicare and Medicare Advantage each take a different approach to the question. Original Medicare vs Medicare Advantage Below is a quick look at how Original Medicare and Medicare Advantage approach the question of having multiple primary care providers. Having two primary care providers if you are enrolled in Original Medicare Patients enrolled in Original Medicare (Part A and Part B) can have two primary care physicians. Actually, you can have as many as you like. Original Medicare puts no limit on the number of doctors you can see. The only condition is that you cannot see more than one primary care provider on any given day. If you have two or more primary care providers, you cannot schedule appointments with both on the same day. You can go to any doctor who accepts assignment, regardless of their insurance network. ‘Accepting assignment’ means the doctor sees patients on Original Medicare (Part A and Part B) plans, and has agreed to take whatever payment amount Medicare has approved for a healthcare service. Watch this quick video on Original Medicare vs. Medicare Advantage for a clearer understanding of your options. Always confirm beforehand if the doctor you wish to see accepts assignment, otherwise it may cost you extra. Having two primary care providers if you are enrolled in Medicare Advantage Patients with a Medicare Advantage (also known as Part C) plan will have to check their particular plan, or ask their insurance provider if they are limited to only one primary care doctor, or if they can see more. In the event that you are allowed to see more than one primary care doctor, you must make sure they both belong to the same insurance network as your specific Medicare Advantage plan. Seeing an out-of-network care provider can result in a very expensive bill. Advantages and disadvantages of having two primary care doctors Having two primary care doctors may seem like a great idea, and sometimes it is. But it may pose quite a few challenges too. Advantages of having 2 primary care providers: If you have two homes and spend a considerable chunk of your time at each, having two doctors lets you see the one closest to you whenever you need. You can get a second opinion if you’re not satisfied with the medical advice from either doctor. You can double check care or treatment plans by running the advice of one doctor by the other. Disadvantages of having more than 1 primary care provider: Instead of coordinated care, you get fragmented care. There’s also a higher

Falling down is one of the leading causes of injury among senior adults aged 65 years and over. According to the Centers for Disease Control, 1 in 4 older adults has experienced a fall within the year. Of so many old people falling, almost half require medical treatment. This is because older adults are at high risk of breaking a hip, wrist, or their spine since bones become weaker and more brittle over time. Why do old people fall so much The natural process of aging sends our bodies into decline, and we may not be as strong or as stable on our feet as we used to be. Chronic illnesses also play a big part in causing falls. A few of the more common reasons for old people falling are: 1. Weakened muscles: The average human body is made up of around 37.2 trillion cells. Some cells are replaced with new cells daily, others are renewed after a longer period of time. Some cells are never renewed. Skeletal muscles are the long muscles that connect to bones and help us move. These include biceps in the arms and hamstrings in the legs. According to one research study, cells in skeletal muscles can take up to 70 years before they’re replaced with brand new cells. Other studies posit that skeletal muscle cells never renew, and injured cells are simply repaired rather than replaced with freshly manufactured cells. Either way, by the age of 65, your skeletal muscles have likely been through a lot. Weakened, and possibly atrophied, aging muscles struggle to support the body, maintain balance, and keep legs steady while walking. 2. Slower reflexes: Reflexes are automatic, fast, and involuntary reactions the body performs to protect itself. For example, when someone accidentally touches a hot surface, they instantly pull their hand back. Whether the person is 70 years old or 7 months old, this reflex action is the same. This shows that reflexes are instinctive rather than learned behavior. Research has determined that reflexes occur when signals from a stimulus (in this example, contact with a hot surface) travel along the network of nerves to the brain, which then sends out instructions on how to respond. With age, our network of nerves, or the nervous system, undergoes a lot of wear-and-tear. Many kinds of nerves cells are not replaced when they die or are damaged. With fewer nerve cells, or neurons, in the communications line, it takes longer to transmit messages back and forth. This means that if you trip, by the time your brain is notified, has processed the information, and sent out instructions on what to do, you may already be sprawled on the floor. Direct aging is just one reason behind slowed reflexes. Other factors include: • Insomnia. Not getting enough restful sleep at night leaves you tired and sleepy in the daytime when you should be awake and alert. A tired brain cannot process and respond to sudden information effectively. • Medications. Certain ingredients in prescription medications may interfere with the workings of the nervous system. Others may cause drowsiness, brain fog, and disrupt attention and focus. • Not drinking enough water. Dehydration leads to an imbalance in the salts and electrolytes in your body. Electrolytes like sodium, potassium, and magnesium are crucial for neuron health. • Cognitive decline. Neurodegenerative diseases such as Alzheimer’s, Parkinson’s disease, and various forms of dementia bring down the number of functioning neurons. This slows down brain activity and reflex speed. 3. Chronic diseases: Almost half of all patients with type 2 diabetes will develop peripheral neuropathy. One form of this disease is a loss of feeling in legs and feet, which makes it difficult to control balance and stability. Diabetes also leads to a frequent need to pee, especially at night. Rushing to the bathroom while half asleep, tottering on numb legs, unable to feel the floor through your feet, all combine to create a tripping hazard for patients with chronic diabetes. Arthritis stiffens and weakens joints, making it harder to move safely, and fluctuating blood pressure, especially hypotension, can cause disorientation, fatigue, dizziness, and blurred vision. How to fall without injury, or reduce the risk of injury Falling down can be embarrassing, but more worrying is the potential to get injured. Falls are unpredictable so you can’t really prepare for one, but if you can remember to go with the flow, you may reduce your chances of getting hurt. Go with the flow: In martial arts such as karate, judo, and taekwondo, practitioners learn to go along with their opponent’s attack. Instead of two opposing forces smashing into each other, one gives way so that both forces move in the same direction. Keep this in mind when you start to tumble. Generally, when we fall our first instinct is to stiffen up to regain balance. Half the time, this doesn’t help much; we continue falling and because of the body’s rigidity, may end up bruising a muscle or snapping a bone. But when you go with the flow and make no attempt to resist — researchers at Harvard University call it falling like “a sack of beans” — your muscles are more relaxed, softer, and better able to cushion your bones. Stay calm as you fall, let your knees, elbows, and wrists go limp, and turn your face away from the ground. After the fall Give yourself as long as you need to catch your breath and process the shock. Check for any pain that may indicate an injury. If you can, get up slowly. You may need help to stand, either from another person or from a piece of sturdy furniture. Even if you do not need emergency care after a fall, let your doctor know ASAP. Also, while the details are still fresh, write down: Where you were when you fell (in your bedroom, at the mall, out on the lawn) What you were doing (walking, just got up from a chair, gardening in the

Heart disease, or cardiovascular disease, is a leading cause of death in the United States. According to the most recent heart disease facts sheet released by the American Heart Association, cardiovascular disease is responsible for 2 out of every 5 deaths. What are the 5 most common heart problems There are many types of heart disease. The umbrella term is cardiovascular disease, and it is split into many subcategories. Where senior adults in particular are concerned, the 5 most common heart problems are: Coronary artery disease Congestive heart failure Atrial fibrillation Valvular heart disease High blood pressure (hypertension) Coronary artery disease: Arteriosclerosis is a broad-category heart condition made up of three diseases. One of these is atherosclerosis. Coronary artery disease, or CAD, is a subdivision of atherosclerosis. With arteriosclerosis, normally flexible arteries harden gradually over a period of several years because of plaque buildup. Plaque is a waxy substance made of fats, cholesterol, and other debris floating in the bloodstream. In people with atherosclerosis (one of the 3 subcategories), plaque deposits clog up the largest arteries — the carotid (in the neck), coronary (in the heart), peripherals (connected to the legs, arms, and pelvis), and renal (in the kidneys). This blocks, dams, and slows down the flow of blood through them. CAD, or coronary artery disease, is plaque buildup in the two coronary tubes that supply blood to the heart. Because it must squeeze through clogged arteries, the quantity of blood supplied to the heart may not be enough, or it may take too long to get through. Delayed and/or insufficient blood supply causes cells in the heart muscle to begin dying, thus damaging the heart and leading to a heart attack. Congestive heart failure: Here’s an experiment: fill a bowl with water, cup your hand, and scoop some water out. You should be able to collect quite a reasonable amount of water. Now slip a cardboard tube (the sleeve on to-go coffee cups works great) on your hand and again try to scoop water from the bowl. The stiff cardboard sleeve will stop your fingers from curling, your hand won’t cup, and you won’t be able to hold as much, or even any water. Congestive heart failure, or CHF, is kind of like this. Your heart doesn’t fill up with enough blood because it can’t pump as well as it should. This could be either because the heart muscle is too stiff or because it doesn’t have the strength to contract properly. When a heart struggles to pump, it may lose its steady rhythm, causing the heartbeat to flail wildly. The beat may catch, speed up, go off track, or suddenly stop. A stopped heartbeat is called cardiac arrest. Studies have shown that without immediate treatment, the brain dies within 5 minutes of a cardiac arrest, and complete death occurs at 8 minutes. Atrial fibrillation: One minute you’re calmly scrolling through your phone, the next you’re gasping for breath, feeling light-headed, and your heart is flip-flopping inside your chest. This could be because of atrial fibrillation, or arrythmia, otherwise known as irregular heartbeat. Electrical pulse in the heart Your heart has 4 chambers: 2 atria above and 2 ventricles on the bottom. Every heartbeat begins with an electrical impulse in the right atrium. The electrical pulse moves across to the left atrium, then down to the bottom chambers. The speed of this electrical impulse is faster in the top chambers and slower in the bottom. As it moves across the heart, adjusting its speed as needed, it makes the chambers contract or expand their attached valves. This way, the respective chambers either pull blood in to oxygenate it, or push it on its way through the circulatory system. Atrial fibrillation happens when the electrical impulses in the upper atria become disorganized and chaotic. This throws the atria out of sync with the ventricles. Think of it as a quartet singing doo-wop harmonies, when suddenly 2 out of the 4 singers break into rap. Atrial fibrillation is triggered by damage to the heart’s structure. In older people, some reasons for this damage could be because of decades of normal wear-and-tear, years of plaque buildup, sections of dead heart muscle, or scar tissue formed by a previous heart attack Note: Atrial fibrillation doesn’t always show symptoms. Your heart’s electrical impulses could spark erratically several times an hour and you might not notice it at all. Valvular heart disease: Valvular heart disease refers to problems with the heart’s valves. A valve is a structure that starts, stops, and controls the speed and direction of flowing liquids, in this case, blood. The human heart has 4 valves: tricuspid, pulmonary, mitral, and aortic. Each valve is attached to one of the four heart chambers. Function of heart valves After blood completes its journey around the body, it lands, depleted of oxygen, in the right atrium. From there, it goes through the tricuspid valve into the lower right ventricle. Then, the blood passes through the pulmonary valve into the lungs where it is enriched with oxygen. The lungs send the oxygenated blood into the left atrium, from where it flows through the mitral valve into the left ventricle. The aortic valve connected to this chamber sends this refreshed blood out to the rest of the body. Heart valve problems happen when a valve that is supposed to keep blood from flowing backward fails to do so. Or, the valvular tissue grows thick and stiff, affecting blood flow. Or, because of a congenital issue called atresia, a valve or part of it is missing since birth. Valvular damage in later years usually happens because of high blood pressure, calcification, age-related loss of elasticity, cholesterol, and smoking. Fun fact: The ‘dub-dub’ sound we identify as a heartbeat is actually the sound of heart valves opening and closing. High blood pressure: Hypertensive heart disease is a heart complication brought on by chronically high blood pressure. It primarily affects the lower left chamber, aka the left ventricle, and

The lines on your palms may or may not reveal your future, but if you turn your hands over and look at your fingernails, you might be able to tell a lot about your health. Fingernails and health: Indicators of systemic disease As long ago as the 5th century, the Greek physician Hippocrates learned that fingernails and health were closely related, and the state of a person’s nails could give lots of clues to hidden systemic disease. A systemic disease is a health disorder that affects a whole system of operations in the body. Systemic disease may therefore cause damage to multiple organs. For example, diabetes is a disease of the endocrine, nervous, and metabolic systems. Unchecked, progressive, or advanced diabetes can cause severe damage to the kidneys, eyes, skin, blood vessels, etc. What are fingernails made of Fingernails (and toenails) are made up of mainly two layers. The first layer is the fleshy, top side of your fingertips, called the nail bed. This is packed with nerve endings and blood vessels. Shielding the soft nail bed is the second layer. This is the hard, shiny covering called the nail plate. How do fingernails grow At the base of the nail plate is the lunula, a slice of white that looks like a crescent moon. The lunula may not always be visible, or may appear on just one or two out of all the fingernails. It is usually most prominent on the thumbnail. Just below the lunula, underneath the skin, is a section of active tissue called the germinal matrix or nail matrix. The nail matrix produces keratin cells that are continually pushed upward and outward, densely packing together to form the hard nail plate. With every new row of cells, the keratin sheet moves along the length of the nail bed and extends past to form the nail tip. Fun fact: Keratin is the same material that makes up hair, and is also present in large quantities in the mix of cells that make up skin. Keratin is also what makes up animal hooves and bird beaks! What do a healthy person’s fingernails look like People in good health would have fingernails and toenails that are shiny, smooth, and hard, with a nice pink or mauve color. The nail tips would be white, and strong yet flexible. That is, they will bend slightly when pressed, but not crack or split. How to examine fingernails for health symptoms Sometimes, nails may be in such obviously bad shape that a glance is enough to let you know things inside your body may not be okay. But even if your nails appear fine, you may want to dive a bit deeper. Sit in a comfortable chair in a well-lit spot, and examine your nails through a clean magnifying glass. Keep a notepad handy to write down or draw what you see. Alternatively, take a photo of your nails with a smartphone or digital camera and zoom in to get a better look. Spot an illness just by looking at your fingernails Unhealthy nails are not always a sign of systemic disease. Sometimes, it could be because of a localized problem like fungal infection, that may be cured with proper treatment. But if your fingernails are otherwise alright and fungus-free, possible underlying health conditions may be revealed from discoloration, damage, poor texture, poor strength, and changed shape. Discolored nails One of the most glaring symptoms of poor health is nail color. Pale nails, yellow nails, or blue nails are all symptomatic of underlying health problems. Pale nail beds: Nail beds get their tone from the mass of blood vessels bundled at the fingertips. Pink or purplish nail beds mean your heart is pumping blood well enough to reach the extremities. Light colored, or almost white, nail beds are a sign of poor blood circulation. This may be because your heart isn’t working at full capacity, or there are blockages in your veins. Light or white nail beds could also be a sign of anemia, liver disease, or kidney damage. Yellow nails: Nail tips often turn yellow from activities like cooking, washing dishes, and gardening. Or they may just be stained from a dark nail polish. Trim the tips and examine new growth. If nails continue to grow out yellow, it may be indicative of thyroid disorders, autoimmune diseases like psoriasis, or lung disorders such as emphysema. Blue nails: Cyanosis, or a bluish tinge to fingernails, is a sign of low oxygen in the blood. This could be because of poor blood circulation, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or pneumonia. Terry’s nails: Terry’s nails are characterized by a mostly white, glassy-looking nail bed and a narrow band of pink or reddish-brown just below the nail tip. The condition is named after Dr. Richard Terry, who noticed that many of his patients diagnosed with cirrhosis of the liver had the same or similar appearance to their fingernails. Damaged nails Nail damage shows up as cracks, splits, and layers peeling off the surface of the nail plate. This kind of damage may happen because of contact with harsh chemicals, but it could also be a sign of poor nutrition, anemia, and hypothyroidism or low thyroid function. Ridges and nail pitting Lightly feel the surface of a nail by running the pad of a fingertip over it. Do you feel vertical ridges on the nail plate? These raised lines could be symptomatic of rheumatoid arthritis. Look closely at the nail plate. Do you see pitting, like tiny pinpricks dotting the surface of your nails? Nail pitting could hint at a weakened immune system, psoriatic arthritis, or cirrhosis of the liver. Thickened nails Hard nails with a reasonable thickness are a sign of good health, but nails that are too thick could mean diabetes, especially if they also appear dry and brittle. People with diabetes are at particular risk of developing thickened toenails since blood flow to the lower legs may be compromised,