Weight loss and diet plan for a healthy lifestyle.

Remember your Uncle Charlie and the problems he used to have reading the newspaper? It seemed as though he had trouble focusing, so he first tried his bifocals. When that didn’t work, he held the paper out at arms length. Then, with his arms fully outstretched, he was finally able to settle into his reading.

But you couldn’t understand why he ended up that way. “Bring it closer, Uncle Charlie, not farther away,” you informed him with the naivete of youth. Or you may have handed him your father’s glasses to try. But while you may have been nearsighted as a child, presbyopia, a form of farsightedness, which is what Uncle Charlie had, is much more common among midlife adults. In fact, as you age, and if you wear glasses or contacts, you may find that your prescription has gone from one extreme to another, from nearsightedness to farsightedness.

Presbyopia is only one characteristic of the aging eye. If you know a man or woman over the age of 50 who has never worn glasses or contact lenses, you should consider yourself to be in rare company. Besides the possibility of having presbyopia as you grow older, you may find that you need to rely on your reading glasses more, whereas before you only needed them for reading or night driving. You may also find that it takes longer for your eyes to adjust to the dark, and even once you’ve become used to the poor light you may not be able to make out certain objects as clearly as you once did. Your eyes may not water as easily as when you were younger, something that is especially true for post-menopausal women.

There’s not much you can do to prevent the effects that each additional year has on your sense of vision. Some ophthalmologists believe that if you work at a computer or a craft where you frequently need to focus on objects up close, your vision will deteriorate less rapidly if you wear regular eyeglasses instead of contact lenses. And remember what your mother told you about reading under poor light? It’s true that the less you strain your eyes, the longer you’ll keep your eyesight intact.

The chances of getting certain ophthalmologic diseases—such as glaucoma, cataracts, and retinal detachment—increase with age, but the good news is that after about the age of 50, your eyesight will stabilize and may even improve significantly. Overall, if you try to stay aware of any changes in vision you experience and visit your eye doctor at the early signs of change, you’ll improve your chances of having healthy eyes well into your 70s, 80s, and beyond.

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If your insomnia is due to a temporary stress in your life, your sleep habits will return to normal once it ends. In the meantime, try to take catnaps during the day whenever you feel tired. The traditional advice for insomnia—warm milk before going to bed and using your bed only for sleeping—may work for you. It may help if you stay busy during the day and eliminate eating late at night and drinking caffeinated beverages past midafternoon. Staying up later until you’re really tired sometimes helps. And if you’re getting up in the middle of the night to urinate and find that it’s hard to fall back asleep, don’t drink liquids after 8 P.M. If your insomnia lasts longer than a week, however, and these suggestions haven’t worked, you should see your doctor. When I complete the examination and conclude that a patient’s inability to sleep is due to stress, he or she often asks me for a prescription to induce sleep. I try to discourage them, since most sleeping medications are extremely habit forming, and the effects usually only last for a few days before they begin to lose their effectiveness. Certain sleep-inducing medications may also cause short-term memory loss.

Medications to help you sleep should be used for only a short period of time to help you get over a temporary period of stress and worry.

The effects of over-the-counter sleeping medications are of a very limited duration. These preparations typically consist of a natural sedative called tryptophan, which is the same substance that makes us feel sleepy after a turkey dinner. Use them only once in a great while, if you must.

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Description and Possible Medical Problems

The movie Vertigo is everyone’s nightmare of a world that won’t stop spinning no matter what you do. If you feel dizzy and faint whenever you stand up from a lying or sitting position, it’s likely that the cause is a temporary one and easy to fix. Most often, a high emotional state, certain medications that lower your blood pressure—most often cardiac and psychiatric drugs—and even prolonged bed rest can make you feel dizzy and faint. Sometimes, even quickly changing positions can bring on this feeling of vertigo.

In rare cases, however, dizziness and a faint feeling can occur in a person who has a bleeding ulcer or severe anemia, which lowers the blood pressure. Any change in blood pressure that results from these illnesses is called orthostatic hypotension.

Treatment

If you think your dizziness is caused by changing positions quickly, try moving around less abruptly to see if that’s all that is necessary. And if you’ve recently been upset or have spent a lot of time lying down and resting, the dizziness should disappear when you return to your previous state. If you’ve recently changed or added a new medication, see your doctor about switching to a medication without these side effects.

If these suggestions don’t help, you should see your doctor, who will do a complete medical history and physical and take your blood pressure when you’re both standing and lying down to check for any significant change. If you have anemia or a bleeding ulcer, your doctor will prescribe a regimen to treat these conditions, which will include medication, diet, and exercise.

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Here’s how I envision the way health care provision will change and how it will affect the first group:

The first group, the purchasers of health care, will expect to be able to choose their doctors, either in an HMO or outside. A health care purchaser who agrees to pay for the deluxe version of traditional, conventional indemnity insurance, will be able to pick any health care provider he wants. But this will be the exception. The majority of health care consumers will participate in an HMO or other group practice plan. The employers and governments that pay for the plan will want to make sure that the doctors, hospitals, and ancillary services provide quality health care. They might also want a plan with an HMO or group practice that emphasizes child care and prenatal and obstetrical care if they have a lot of employees with families. On the other hand, if the company is in an industry that’s particularly stressful, it will want to make sure the plan provides psychological care benefits. The plan the purchaser ultimately selects will depend on cost, quality of care, and availability of service.

The aim here is to assign each patient in the HMO to one primary care physician—who is usually a generalist, a primary care internist, a family practitioner, a primary care pediatrician for those with children, and an OB/GYN for women, which some insurance plans will cover. This physician will serve as the captain of the patient’s health care, and the patient will see this physician before any testing or further specialists are ordered. The purpose is to establish a close relationship between the physician and the patient and to use only tests and/or specialists that are absolutely necessary, which will help to eliminate duplicate and unnecessary tests. This will help save money for the purchasers of health care—both the employer and the insurance company. In turn, the primary care physician will be monitored by the insurance company to make sure she is providing good care at a reasonable price. The insurance company may also look, for instance, at the number of patients in the HMO who have diabetes and suggest that this group be referred for nutritional counseling or perhaps for eye exams. This will cut down on future medical costs and also maintain current expense levels.

With this new model, the primary care physician will be paid less for the services he provides for each patient, as compared to his old fee-for-service days. But the advantage of this plan is that the doctor serves as the gatekeeper, which ensures improved care, and that medical costs across the board are controlled. Quality is also maintained because the insurance company may institute a plan in which it will issue a periodic report card for each health care provider that will show how each professional in the group is performing.

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To help your doctor diagnose your illness, you should also try to be as specific about your symptoms as you can. The phrase “I just don’t feel well” can be frustrating for your doctor to hear, because it doesn’t tell him anything. A few ways in which you can be more specific about your symptoms is to ask yourself the following questions:

• Have I recently lost or gained weight?

• Do I feel more tired than usual?

• Do I feel a pain somewhere in my body? Is it sharp or dull? Is it constant, or does it appear after a particular activity?

• Is my temperature over normal?

• Has my appetite changed?

• Do I feel short of breath?

• Have I noticed a change in my personal hygiene?

The amount of time you’ve had your symptoms is also important. If you have had a number of different symptoms for more than a few days, you should be sure to tell your doctor how many days, weeks, months, or years you’ve had that particular symptom. And if you’re trying to read the Body Signals of a family member or close friend, ask him or her these same questions as they pertain to his or her condition.

Remember, relying on the doctor inside you will speed up your own

physician’s diagnosis and treatment plan and ultimately your own recovery as well.

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