In sailing, the technique used to move upwind (or against the wind) is called “tacking.” Although tacking is actually a combination of vector mathematics and boat design, to most of us, it refers to the concept of making forward progress by zigzagging rather than moving forward directly. For adult children helping their parents transition from one home to another, tacking can be a very useful technique.

I met recently with a woman in her early eighties. She suffered a stroke last summer, and a few months later, she lost her husband. They had planned to move to a nearby retirement community, and my client decided that she wanted to continue with that plan even though her husband was no longer with her. As she recuperated from the stroke and dealt with the loss of her husband, one of the tasks that gave her great pleasure was planning her new home, a large two-bedroom villa separate from the main building on the retirement campus. She worked with a decorator and implemented a number of changes that made the villa her own. Financially and emotionally, she was considerably invested in the villa.

For nine months after her stroke, she was not permitted to drive. Shortly before her planned move, she underwent an evaluation to confirm her ability to resume driving, and was crushed to learn that she did not pass. Without driving, her children maintained, moving to a villa detached from the main building was a mistake. She would be cut off from activities and socialization—key factors that had motivated the decision to move in the first place. It was likely that she would need to move again, to an apartment within the main building, within a few years. Wouldn’t it be better, they argued, to move just once?

While I understood the children’s point of view, we saw the issue through different eyes. In less than one year, my client had lost her health, lost her husband, lost her ability to drive and was leaving her home of forty years. The villa had been something to reach for and move toward, something in which she had invested time, energy and passion, and now her children were suggesting that she lose that as well. How much can a person lose at one time?

My client clearly preferred the villa to the main building. I hoped her children would support her decision, and fortunately, they did. If and when my client moves from her villa to an apartment at some point in the future, the difficult transition from single family home will already have been made. She will change spaces, but will be staying within a community that is already home.

The lesson here for adult children, perhaps, is to remember this sailing metaphor, and how moving forward in the face of a strong wind requires going from side to side, not straight ahead. Sometimes getting parents to agree to move requires supporting a decision that may not seem optimal. What matters is that it’s one that works. Adult children who can keep this perspective will reduce conflict and improve the quality of their interactions with their parents, confident in the knowledge that going sideways is sometimes the most straightforward path.

Several months ago, I received a copy of a very thought-provoking book, The Best Way to Say Goodbye: A Legal Peaceful Choice at the End of Life, by Stanley A. Terman, PhD, MD. It is an exhaustive resource on a method that can be used to end one’s life through the voluntary refusal of food and fluids.

It is difficult for most people to discuss end of life. It only gets more difficult when you consider when and under what circumstances you might wish to end your own life, and when you consider the personal, political, religious and moral aspects of doing so. Terman addresses all of these complicated aspects, and reminds us that people have chosen to die in this fashion for many, many years. A person’s right to die is as old as humankind and each age and culture throughout history has their response to this intention and the carrying out of this act.

Perhaps the best way to approach the discussion about end of life is by considering some of the most important questions. What do you want in your life as you get older? Under what circumstances do you wish to remain alive? These are tough questions, but they need to be answered. Don’t forget these key considerations:

• Speak with the people who will make decisions for you, and those for whom you will make decisions. Ask them what they would want done, and what they would not. You may be surprised at what you hear.
• What is the extent of treatment that you feel is acceptable? When do you think it is time to end treatment? When would you want to extend treatment? Regina, my mother-in-law of blessed memory, always said, “I don’t want to be a vegetable.” She let us know that when she stopped being herself, she no longer wanted to be alive.
• How does your religious and/or ethical path guide you in your decisions? A client of mine with Alzheimer’s was treated rigorously throughout the course of his disease, given antibiotics each time there was an infection, had a stomach tube and lived as long as his physicians could keep him alive because that was within the dictates of his religious belief.
• Consider who will make decisions for you. If you disagree with a relative or child about extent of treatment, consider having others take on the role of health proxy.
• Is your physician amenable to your wishes? The New York Times recently wrote about a practice called “slow medicine, which encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.” Geriatricians are traditionally in synch with their patients, and more comfortable with limiting treatment than doctors who work with patients of all ages.

After you have discussed your wishes with a close friend or family member, you can meet with a geriatric health care professional such as a physician, nurse or social worker to learn how to most effectively record your wishes. A health care proxy is the essential tool to record these wishes and legally designate people (proxies) to make medical decisions on your behalf if you are unable to do so at some point in the future.

For more information on Dr. Terman’s work, visit www.caringadvocates.org

Be well,

Arleen

When shifting circumstances bring unexpected elder care costs, they also bring the urgency of having to make short and long-term financial decisions. It is at this point that one must confront the reality of the exorbitant costs of care for the chronically ill and elderly.

In 2007, the annual cost of long-term care in the US averaged $77,000. While many people are woefully unprepared to handle these high costs, many others have serious misconceptions about the real costs of long-term care and how much they will have to pay. Consider these surprising facts:

• Medicare only covers 8% of assisted living and in-home care costs. Medicare, Medicare Part D and Medicare supplemental plans will only cover short-term and medically required costs.
• The average cost of nursing home care is approximately $300 per day.
• In 2007, in-home care costs increased by 12%.

Formulating a Financial Strategy

Paying for long-term care is a significant expense. You’ll want to consider all of your options before committing to a plan. To start with, ask yourself the following:

• What is the present income stream?
• How much will the expenses be, considering all alternative solutions?
• How can you bridge the discrepancy between present income and future costs?
• What financial preservation strategies are available?

Once you’ve answered these questions, it’s time to identify, analyze and evaluate your financial resources. The majority of elder care costs are provided and paid for by the aging individuals and their families; therefore, I’d like to focus briefly on how to unlock these private resources. I advise my clients to consider the following resources.

Insurance: Long-term Care, Life & Annuities

• What are the benefits and how can you obtain them?
• What is the cost of tapping these benefits?

Assets: Investments, Savings & Retirement Funds

• What is the value of these assets, both individually and bundled?
• Consider the safety and liquidity of all assets.
• Can they facilitate income to meet expenses?
• What are the true net financial returns or benefits of alternative solutions?
• Consider all associated costs, such as taxation impact, cost of sale and acquisition fees.
• How are the assets legally held (e.g., trusts)? Understand the specific terms.

Real Estate

• Are there income production possibilities that don’t presently exist?
• Consider the capital gains taxation on a possible sale. Does it make sense to sell?

Financing: Real Estate Equity Loans & Reverse Mortgages

• Understand the true costs, including all associated fees. Compare APRs (annual percentage rates).
• What are the alternatives to meet the needs of “aging in place”?

Personal Property

• Assess the financial value of personal property such as jewelry, art, collectibles and antiques.
• Consider the personal value of these items before deciding what you want to do with them.

To produce more income, you can convert investments to generate more cash flow or decide which assets to sell, or spend down, to meet the new financial demands. In making these decisions, don’t forget to consider all costs involved, and determine the true net benefits and/or returns of any new choices made with the proceeds. Do a thorough cost-benefit analysis or ask a professional with elder care financial expertise, experience, and legal fiduciary obligation, to help you do it. You might also want to talk with an elder care attorney, geriatric care manager or financial planner.

When making these crucial care and financial decisions, avoid band-aid solutions. Denying future circumstances can be financially devastating down the road if you don’t consider them now. Determining the best solutions requires comprehensive, objective planning, to ensure needs are met, resources are not exhausted, and all cost-effective strategies are utilized.

One last point: there are also strategies that can be built around incorporating the resources of the family (i.e., time and money) to take advantage of a variety of available options, such as sharing the caregiving duties and/or costs. But don’t forget the bottom line: these financial decisions should be based on the needs of the individual who need care!

“Whether you believe you can do a thing or not, you are right.”

—Henry Ford

Our thoughts and beliefs are very powerful. What we focus on expands in our lives, what we dwell on becomes our experience. That little voice inside our heads that never lets anything go without a comment, remark or evaluation, can be very critical and unforgiving. What we say to ourselves can determine our attitudes, shape our choices and influence how we live our lives. How many times has each of us said, “I’m not good enough,” “I can’t make changes,” “I can’t do it,” “I’m not smart enough” or “I’m too old”?

Negative self-talk takes many forms. It might stem from comments made by well-meaning people. Our family, friends or partners may express their opinions or limiting beliefs to us in a negative way. It might simply come from sharing a story of something terrible that happened to someone else. Even the newspaper, the television news and advertisements can perpetuate negative beliefs we have in ourselves. Do you watch television shows, movies or listen to music that denigrates others? We begin to believe what we have heard because repetition is a convincing argument and the brain believes what it is told over and over again. It’s no wonder that researchers have shown that 75% of the thoughts we have every single day are negative.

As humans we are creatures of habit and it is easy to continue to think and communicate in the same way. The words we use in our everyday language are an indication of what we think and believe.

Awareness is the first step toward change. Pay attention to how you express yourself in conversation and what words you use. Each word is a choice and these choices can have a huge impact on others. Words of encouragement can inspire, while words of disappointment can dishearten.

For a few days, be aware of how you communicate with others. Have you ever paid attention to the things you say? How many times do you use negative words such as should, can’t, don’t, and never? Do you rush to repeat negative stories and share bad news? Do you listen attentively to what others are saying or are you anxious to tell your own story? Become conscious of what your negative self-talk says to you about yourself and others, and how you then choose to communicate that with others. Remember: it is a choice.

The words we use shoulder a huge responsibility. Be gentle and kind not only for the sake of others, but for your own sake as well. In the wisdom of Buddha, “Words have the power to destroy or heal. When words are both true and kind, they can change our world.”

Last week I gazed at photos from my fortieth high school reunion. Some people looked exactly the same, but most had changed. Some were thinner, some were heavier, many were gray-haired. I spent the most time looking at pictures of the girls I had placed on pedestals during high school—the pretty, the popular, the thin. I was so hard on myself then. Sometime during the past forty years I came to accept who I am—the good and the bad—and it was immensely satisfying to realize that I am okay with all of it.

As I reminisced about my personal journey, I thought about reminiscence literature itself, which is based on the act of reflecting upon one’s past and the idea that it helps individuals, especially older adults, achieve closure, acceptance, forgiveness and wholeness—and that these feelings in turn improve that individual’s quality of life in the present.

I also thought about the clients with whom I have worked and the natural storytelling that occurs as one sorts through his or her own possessions. Senior move managers instinctively understand the importance of listening to clients’ stories. Always pragmatic, we believe that the act of reminiscing helps clients realize that they can take memories with them without taking the things themselves. But I realize now that reminiscence is much more than just that. Reflecting about the past helps clients integrate the varied aspects of their lives and achieve acceptance, cohesion and peace.

It is this renewed appreciation of the value of reminiscence that I wish to share with my employees, my fellow senior move managers, and the many adult children with whom we work. The stories that parents tell, whether for the first or fiftieth time, have a function that extends far beyond the immediate context. Listen and value their communication. Know that the telling helps integrate a lifetime of experiences and enhances the experience of the present as well. A story is much more than a story. Accepting oneself is a precious rite of passage in which, by listening, we play a privileged role.

I recently read an article that indicated the use of drugs that block stomach acid may be associated with cognitive impairment in older African-American adults. According to the study, the risk for showing signs of cognitive impairment is 2.5 times greater for patients using these medications¹. Another study showed acid-blocking drugs to increase risk of pneumonia². More than 16 million prescriptions of acid-blocking drugs were dispensed in 2005, and several of these medications are also available over the counter. Heartburn drugs are among the most widely prescribed medications in the United States, accounting for more than $13 billion in annual sales.

Oh my. I feel another “soapbox moment” coming on. As a holistic practitioner, I have been keenly aware of the potential long-term side effects of these acid-blocking drugs for some time now. From food allergies and depression to poor calcium absorption and rosacea, we often recognize low stomach acid—and thus, poor digestion—as the root cause of chronic inflammation and many other health problems. I realize the conventional medical field does not acknowledge this. For example, a nurse practitioner once told one of my patients that humans didn’t need stomach acid anymore, and that it was an “evolutionary holdover” from when we as humans used to eat bark. Hmm?I respectfully—but completely—disagree. I believe, as do many of my holistic colleagues, that we not only need stomach acid, but most of the symptoms normally attributed to too much stomach acid are actually from too little.

Our bodies put a lot of energy into the production of stomach acid. Why do they do this? Are we unknowingly munching on bark in our sleep? Actually, acid is part of the process of digesting proteins. It protects us by killing bacteria, viruses and fungi before they can enter the body. It turns the vitamins and minerals in food into forms our bodies can absorb and use. In addition, when we don’t have enough stomach acid, the muscle (lower esophageal sphincter) that keeps stomach contents from bubbling up into the esophagus does not close properly, thus creating acid reflux and the symptoms of heartburn. Other symptoms of low acid are bloating, belching, farting (that’s the technical term), indigestion, diarrhea and constipation. The use of antacids temporarily masks symptoms, but in the long run it is exactly the wrong treatment for most people. Lastly, when the stomach is not allowed to produce acid, the rest of the gastrointestinal tract is adversely affected. Either it is not stimulated to do its job properly or it is exposed to inadequately digested proteins which aggravate it.

Excuse the pun, but I realize this is a bitter purple pill to swallow. Unless you have been told you have an ulcer or a hiatal hernia causing your symptoms, chances are you need to stimulate more acid secretion. One simple trick is taking a half teaspoon of organic apple cider vinegar in half a cup of water before meals. For many of my patients, this is all that is needed to stop acid reflux. I also recommend reducing alcohol and inflammatory foods and not eating late at night. In addition, I urge you to read the book Why Stomach Acid is Good For You: Natural Relief from Heartburn, Indigestion, Reflux & GERD by Jonathan V. Wright, MD, and Lane Lenard, PhD. In conclusion, I cannot emphasize enough just how important proper digestion—including adequate stomach acid—is to the overall health of your body. To borrow a quote: When asked about the importance of digestion, a Chinese medicine doctor replied in a matter-of fact tone (please imagine a Chinese accent here), “Stomach bad, you die.” That pretty much sums it up.

Take care of your (whole) self—

Amy Bader, ND

Read more about Anti-Inflammation Diet, Healing Through Diet or Naturopathic Medicine.

Aerobic exercise is exercise that rhythmically uses the large muscles of the legs and arms to elevate the heart rate within a certain range. Some examples of aerobic activity include brisk walking, jogging, swimming, bicycling, gardening, dancing, playing actively with children, and sexual activity.

Recommendations for Aerobic Programs

If you have a Karnofsky score of 50–70%, you can begin with five minutes of exercise at 55% of your MHR three times per day, adding one minute to each interval each time until you achieve ten-minute intervals. Follow this program six to seven days per week. Then reduce the number of intervals to two per day, adding one minute each time until you achieve fifteen minutes. When you reach that point, exercise once a day, add on a minute each day and follow the program prescribed for those with a Karnofsky score of 70–100% (above). In addition to determining your exercise intensity by taking your heart rate, use the Borg Rating of Perceived Exertion (RPE) scale. Your RPE for the conditioning phase should be eleven to fourteen.

Dynamic Resistive & Isometric Exercises

Dynamic resistive exercise is performed with weights or resistive tubing. The joints are moved through excursion of the various range of motions. The force applied is sufficient to result in increased fiber thickness of the muscle belly. Isometric exercises are performed with the same types of resistance, but do not involve joint movement or can just consist of contraction (squeezing) of the muscles without any movement of the limb. Examples include holding in your stomach, tightening your buttocks and holding your leg straight. These squeezes are held for six seconds and released.

Most people are more motivated when they exercise in group settings such as in a class or with a professional, but if you prefer, there are many well balanced programs on tape or DVD that you can do at home, or you could also purchase exercise equipment for your home that would provide the necessary activity. If you go to a health club and work with a personal trainer, be sure to explain the specifics of your illness to the trainer before beginning your exercise program.

Three-Stage Cancer Exercise Program

Cancer Supportive Care recommends a three-stage program of progressive exercises that helps in maintaining physical function through all stages of cancer treatment. Following is a brief overview of the program.

Stage I: In Bed

During this initial stage when patients are too ill to get out of bed, they can start with range of motion activity for all four limbs. These exercises are very gently and do not have any resistance other than gravity.

Stage II: Bed/Chair with Resistance

The second stage of the exercise program is designed for patients who are out of bed part of the day and walking around home, and, in a limited capacity, into the community. It incorporates the use of weights and other resistive devices like surgical tubing.

Stage III: Up & Around

The final stage of the exercise program involves general fitness activities for patients who have recovered enough to go out into the community. The activities can be used to help the patient regain full prior function or simply as an introduction to a healthier way of life after recovery.

Precautions for Beginning Your Exercise Routine

Consider the following safety guidelines as you begin your exercise program. There are many factors, including side effects from medication, which will affect your ability to exercise.

• Do not exercise if blood counts show any of the following:
  A. Abnormal levels of sodium and potassium (electrolytes)
  B. Abnormal protein
• If you experience numbness in your legs or hands (which could be due to Oncvin, Velban, Vincristine, Vinblastine, Platinol, Taxol, Taxotere or Euflex):
  A. Alternately contract and relax limbs
  B. Avoid excessive weight-bearing activities and alternate walking with cycling, avoiding uneven surfaces
• If you have an infection, anemia, low blood pressure, bleeding (possibly due to abnormal blood count and plasma volume, and all chemo drugs):
  A. Identify nadir period (7–12 days post chemo) and avoid public swimming during this time
  B. Check lab values
  C. Drink lots of fluids
• If you have cardiac problems (possibly due to Doxorubicin, Cerubidine, Idamycin, Vovantron or Pharmarubicin):
  A. Monitor EKG and blood pressure
  B. Watch for swollen ankles, shortness of breath and consult your physician
• If you experience bone weakening (a sign of long-term Prednisone use)
  A. Strength train with resistive bands—no heavy weights!
  B. Be careful when walking
• If you have pulmonary tumors:
  A. Watch for shortness of breath
  B. Have neck/back pain evaluated for spinal cord compression or bowel obstruction

Yoga for Seniors & Cancer Patients

Yoga can help a person react to stressful situations by counteracting many of the body's natural responses to stress. Many yoga practices activate the parasympathetic nervous system, bringing relaxation and restoration to the body by stabilizing blood pressure, lowering heart rate and the body's demand for oxygen, slowing breath rate, increasing lung capacity, improving digestion, increasing feelings of calm and tranquility and bringing about measurable improvements in the immune system. In a yoga class designed especially for older adults or cancer patients, students are encouraged to gently extend their awareness of their physical, emotional, sensory and thinking levels. They practice a slow, deliberate yoga adapted to their own needs and physical limitations. Attention to breathing and a focused awareness of the movements and the stillness of each yoga pose characterize this particular style of yoga.

As the body gains flexibility and the breath deepens, the mind and emotions settle into greater ease and balance. In quiet times of deep relaxation and meditation, habituated patterns of thinking and behaving may become more obvious and lend themselves to change. Yoga practices include yogic postures and stretches, breathing practices, imagery, meditation and progressive relaxation. While each technique has its own specific purposes, all have the common aim of helping one develop a focused awareness of what is happening in the body and mind on an emotional, physical and spiritual level.

Read Exercise Guidelines for Seniors & Cancer Patients: Part 1.

The medical literature has documented causal relationships between the benefits of exercise in cancer prevention and treatment and quality of life issues. Although specific dosages for exercise programs have yet to be established, some guidelines based on research in nonclinical populations offer clues. For example, detrimental effects on the immune systems in athletes suggest that cancer patients would benefit from exercise at moderate levels rather than intense.

For nonclinical populations, the National Institute of Health (NIH) recommends a program of moderate exercise that includes activities such as walking, climbing stairs, gardening and playing with children. These activities should be performed six to seven days a week and can occur in three ten-minute sessions. The same moderate prescription is recommended for cancer patients.

The American College of Sports Medicine (ACSM) recommends that patients with cancer and other chronic illness undergo treatment exercise programs that help them maintain cardiovascular endurance, muscular strength and level of functioning. Scientific research shows that walking or bicycling thirty to forty-five minutes per session, three to five days a week produces the following benefits: decreased nausea, decreased fatigue, increased physical endurance and increased quality of life. The benefits are believed to come from effects on hormone levels, belly fat and intestinal function. The hormone effects produced by exercise are believed to positively impact mood as well.

Both aerobic and resistive exercises improve muscle strength and the functioning of the cardiovascular system (heart and lung circulation). Aerobic exercise has the added benefit of increasing the red blood cell count, positively affecting the fatigue suffered by patients undergoing cancer treatment. The main goals of an exercise program while a patient is undergoing cancer therapy are to minimize the loss of muscle tone and flexibility and maintain overall body condition. The better condition your body is in, the better you will tolerate the side effects of chemotherapy, radiation and other invasive treatments. It will also be easier to do the required activities of daily living (ADLs).

The Warm-up

Begin each exercise session with a warm-up. Warm-ups start you moving slowly and gradually increase the blood flow to the muscles to prepare them for further work. Begin with checking your resting heart rate. If your rate is above 100 beats per minute, do not exercise before checking with your doctor. The warm-up should be sustained for two to three minutes and should elevate the heart rate ten to twenty beats above resting. This should correspond with an RPE score of eight to nine (see chart below). Try the following movements for your warm-up:

• Shoulder shrugs
• Alternate shoulder rolls
• Wrist rolls
• Alternate opening and closing of the hands
• Arm lifts to the side, front and back
• Elbow bends or bicep curls
• Alternate arm lifts to ceiling
• Double arm reaches to ceiling followed by pull downs
• Toe taps
• Heel touches
• Small knee lifts
• Marching
• Stepping from side to side

Borg Rating of Perceived Exertion (RPE)

One method of determining the intensity physical activity is by applying the Borg Rating of Perceived Exertion. Perceived exertion is how hard you feel your body is working. It is based on the physical sensations a person experiences during physical activity, including increased heart rate, increased respiration, increased sweating, and muscle fatigue. Although the RPE is a subjective measure, a person's exertion rating may provide a fairly good estimate of the actual heart rate during physical activity.

Practitioners generally agree that perceived exertion ratings between twelve to fourteen on the Borg Scale suggests that physical activity is being performed at a moderate level of intensity. During activity, use the Borg Scale to assign numbers to how you feel (see instructions below). Monitoring how hard your body is working can help you adjust the intensity of the activity by speeding up or slowing down your movements.

Pay attention to the cues your body gives you, including your breathing rate, how fast your heart is beating, and the fatigue in your working muscles. Take all cues into consideration and assign a number as to how hard the work feels. For example, a six is how you might feel sitting comfortably in a chair and resting. Above eighteen would be working so hard physically that you couldn't continue for more than several seconds.

Borg Rating of Perceived Exertion (RPE) Table

Follow the warm-up with three to five minutes of stretching, then begin your aerobic exercise of choice. The duration and intensity of the conditioning portion of the exercise session is based upon your functional status as a patient.

Karnofsky Performance Scale

The Karnofsky Performance scale is used to determine a patient’s level of exercise.

The next article in this two-part series will teach you how to gauge the aerobic exercise portion of your program.

Recently I wrote an article entitled “How to Hire a Realtor Who Specializes in Working with Seniors.” Once you’ve decided whether you want to work with a realtor who specializes in working with a senior clientele, it’s time to compile a shortlist of candidates and begin scheduling interviews. Let’s consider eight essential rules of thumb that you’ll want to keep in mind for these next crucial steps in the hiring process.

1. Ask someone who works with seniors if they know a great real estate agent.

There are two reasons for this. First, real estate agents cannot give or get kickbacks for referrals. Because of this, the only reason real estate agents get referrals from other professionals is because they’ve earned a reputation for doing a great job. Second, professionals who work with seniors are a wonderful resource because they know firsthand how the needs of a senior can differ from the needs of the general public. It’s very important for the real estate agent who gets referred to a senior client to do a great job; otherwise, both the senior professional and the referral look bad.

2. Get to know the real estate agents you’re considering for the job—and interview at least two of them!

While you may expect to find some big differences between brokerages, keep in mind that real estate agents are independent businesspeople. As such, you may find two agents from the same brokerage who do things very differently. It’s worth spending the time to get to know the professionals whom you’re asking to handle the sale of one of your largest assets. Ask whether the person you’re considering is a full-time agent, who will be your main point of communication, and ask for references from past clients. Don’t forget: work with someone you like!

3. Get to know the brokerage firm.

Although the brokerage you go with isn’t as important as the real estate agent with whom you choose to work, there are certain factors that may influence your decision. Here are a few questions to consider: How long have they been in business? What are their hours of operation? (They should be open seven days a week for your potential buyer.) Are they local and reputable? What is their market share in the neighborhood where you live?

4. Understand the marketing plan.

Creating the marketing plan is one of the most important things your listing agent will do for you. It should identify who’s the most likely buyer for your home, how your buyer usually shops and how your buyer will be targeted. Depending on the kind of home you have and where it’s located, you may want ads in the paper, print ads in real estate magazines, open houses, mailings, Internet advertising or a combination of these marketing efforts. Your listing agent should make information about your house available seven days a week, twenty-four hours a day. By the way: get the marketing plan in writing.

5. Establish how you’ll get updates on the market and on feedback from showings.

One of the biggest complaints consumers have is that they don’t hear from their real estate agents often enough. Ask your agent how you’ll be informed about how many times your home was seen on the Internet, feedback from open houses and realtor open houses, and feedback from buyers’ real estate agents.

6. Stay in the driver’s seat.

A good real estate agent knows the local real estate market and stays on top of the most recent technology to market your home effectively. A great agent knows how to show you information about the local market and the most recent trends in marketing so you’re in a position to make informed decisions about your home. If your real estate agent makes recommendations and you’d like more information, just ask. For example, “I understand your recommendation. On what information are you basing that recommendation?” Never be afraid to ask why something is or is not being done to sell your home. You are the client, and you are in charge.

7. Ask whether your agent offers any other services to simplify your move.

Real estate agents run their own small business, so you’ll find some, particularly those who specialize in working with seniors, who offer additional services. These services could include staging your home, helping you find a senior housing community, and hiring movers or an electrician, plumber or handyperson to get your home ready for market. If your real estate agent does offer these additional services, ask whether they cost extra or are included in the commission.

8. Ask about commissions—but consider all the factors before making your decision!

Many consumers who are shopping for an agent make the mistake of comparing them solely on the basis of what they charge for commission. For example, if Rick Realtor charges 8% and Sally Seller charges 3%, you may decide Sally is a much better option. But what if Rick pays the buyer’s agent 4%, and Sally pays the buyer’s agent just 1%? What if Sally is a part-time agent and her office is only open on Wednesdays and Thursdays from noon until 3:00? Is it still a “good deal”? Make sure you understand how long the listing agent wants to have you under contract, how much he or she will pay the buyer’s agent, and what will be done for you from the time the home is listed until the home clears escrow.

Did you know that there is one thing you can do to reduce your stress levels, enhance your ability to perform the activities of daily living (ADLs), and potentially boost your immune system? Well, there is: it is called exercise. Exercise can increase your quality of life and enhance feelings of independence and self-confidence. There is no magic to it. You just need to do it!

The medical community, fitness professionals and physically active people with chronic disease all agree that the benefits of exercise are very significant. When engaged in at moderate levels, exercise allows the organ systems to positively adapt and improve metabolic efficiency, thereby allowing for more intensive cancer treatments, fewer side effects and better rest and sleep patterns.

Exercise doesn’t need to be intense to have these benefits. In fact, many cancer patients exhibit muscular weakness, decreased functional capacity, and fatigue, which prohibits them from engaging in intensive exercise. Too, cancer patients often feel lethargic during certain points of their chemotherapy and/or radiation cycles. This is very normal and indicates that the body and the cancer are being affected by treatment. Allowing the body time to heal and rest is just as important as building muscle and enhancing cardiovascular strength and endurance. Listen carefully to your body during any physical activity and act accordingly. Err on the conservative side when determining the time, type and intensity of an exercise activity, particularly if you are undergoing treatment.

Benefits of Exercise

Exercise affects individuals in very different ways. Remember that the long-term benefits of regular exercise outweigh the immediate discomforts when done properly. The wonderful thing about exercise is that the effects on both body and mind are substantial and long-lasting. The physiological effects of chronic illness and cancer treatment can be extremely damaging to normal tissue and normal body functions. This damage can occur differently in every patient, so it is important to listen to your body carefully and communicate anything unusual to your instructor, trainer and/or doctor. Adjustments are easy to make in any exercise program and will ensure your safety. Some of the physiological benefits of exercise include:

• Enhanced restfulness and better sleep patterns
• Maintenance or strengthening of cardiovascular system
• Enhanced flexibility and range of motion
• Correcting muscular imbalances resulting from cancer treatment
• Detoxification through sweat and better circulation
• Maintenance or regaining muscle tone and strength
• Increased oxygen to brain and tissues
• Reduced fatigue

The psychological effects of cancer treatment and treatment of other chronic diseases can sometimes prove to be as damaging as the physiological ones. In fact, they may be more important, as far as enhancing quality of life. Some of the benefits include:

• Stress reduction
• Relaxation
• Improved sleep
• Enhanced feelings of independence and self-confidence
• Refocusing energies from illness to wellness
• Mood elevation

Starting an Exercise Program

Check with your doctor(s) before beginning your exercise program. Ask if you should be aware of any special considerations. If you are going to join a program or work with a trainer, it is standard procedure for the program director or trainer to ask for a letter signed by your doctor giving you permission to start the program.

The key to most successful exercise programs is to start slowly and to develop and maintain a routine, particularly if you do not have an extensive exercise history. During any activity, if you experience any unusual physical symptoms, stop immediately. Some common symptoms to look out for are: shortness of breath, chest pain, dizziness, muscle pain, clamminess, headaches, irregular heartbeat, excessive sweating and any joint or limb pain.

When you are starting out, think about the type of exercise and surroundings that you enjoy most. Some people love the solitude of exercising alone, while others need a group to maintain motivation and prevent boredom. Exercising with others is a good opportunity to spend time with friends, family or other survivors, and to share the road to better health and wellness.

Walking is a great activity to begin with. Before you begin, get shoes that support your feet. If you are just starting, set a realistic goal. Even two to five minutes can be a good goal. As your strength increases, add a little more time. A long-term goal may be to work up to twenty minutes twice a week, and then thirty minutes three to four times a week. When you walk, keep your head held high, your shoulders back and abdominal muscles held in. Enjoy the scenery, and stop and smell the roses— that’s part of the pleasure!

You will need to drink a lot of water during any activity you engage in. It is important to your overall health to stay hydrated, especially during treatment. The body continually loses water. Get in the habit of carrying a water bottle with you to remind yourself to hydrate.

If you aren’t familiar with the exercise facilities near you, look in the phone book. Try to find a place close to your home or work so that it will be easy to work into your routine. If you like a facility, schedule a tour before signing a contract to make sure that it is clean, the staff is friendly, and that you are comfortable there.

Ask your doctor for recommendations as well. There may also be community-based programs designed specifically for cancer survivors that are available at little to no cost. Take advantage of these programs if you can. The staff is generally more knowledgeable and compassionate regarding symptoms of fatigue, nausea, lethargy and weakness, and cosmetic concerns. They can better formulate an appropriate regimen, help alleviate apprehension and introduce you to people experiencing similar effects.

If you can afford to hire a personal trainer, that person can design a program to meet your specific needs. Consider the trainer’s education and level of experience. Does the person have an undergraduate degree in an exercise-related field or hands-on training in an area related to your needs (cancer and exercise, pilates, yoga, massage, working with older adults)? Has the trainer earned a nationally accredited fitness certification? The American College of Sports Medicine (ACSM) certification is considered the gold standard in the fitness industry. Other recognized certifications include the American Council on Exercise (ACE), and the National Academy of Sports Medicine (NASM).

Activities to Try

Whether you are an exercise veteran or are new to the fitness arena, it is important to try new things to keep your exercise routine fresh. The following practices require some instruction, which may be found in books, videos or in group classes if you don’t have a trainer. Give these activities a try—you may enjoy them so much it won’t even seem like exercise!

Pilates

Joseph Pilates began developing his increasingly popular exercise method in the late 1890s in an effort to overcome ailments suffered from asthma, rickets and rheumatic fever. He studied Eastern and Western medicine, yoga, Zen meditation and exercise regimens of the ancient Greeks and Romans. The method proved so successful for him that at the age of fourteen he was able to pose for anatomical charts and had become a diver, skier and gymnast.

Pilates focuses on strengthening the abdominal, back and other postural muscles (those supporting the spine), which, together, are referred to as the ?core?. The dance and rehabilitation communities have embraced this method for many years, and recently the mainstream fitness arena has exploded with enthusiasm for Pilates exercises.

Pilates exercises can be practiced on the floor or with specialized equipment. The main piece of equipment is called a reformer. This is an excellent practice for postural enhancement and can be as challenging and physically rewarding as any traditional resistance program.

Water Exercise

Water exercise classes and activities have gained continued popularity over the last several years. Exercising in the water is extremely beneficial to people with orthopedic issues. Many people who cannot exercise on land due to these issues have had a lot of success in the water.

If you are currently in radiation treatment, you should consult your doctor before going in a public pool, but most people have a far greater benefit than problems with skin issues.

Ask local facilities that have pools about the programs they offer. Go several minutes early the first time you attend a class to let the instructor know you are new, and share pertinent information about your current health status.

A good instructor will keep an eye out for you and suggest necessary modifications, and may even provide some one-on-one instruction to maintain your safety and ensure your success.

Physio Balls

Physio balls, also known as stability balls or exercise balls, are another fun way to incorporate exercise into your lifestyle and feel like a kid again! These large inflated rubber balls were previously used for back rehabilitation exercises, but have evolved into the mainstream fitness arena with great success. Working with physio balls enhances core strength, helps you stretch, and allows you to develop and maintain your balance.

Rollers

Rollers are Styrofoam cylinders that help develop core stability, breathing, flexibility and postural enhancement. They are wonderful and easy to use. Rollers were previously used for rehabilitation purposes as well, but have also experienced a rebirth into the traditional fitness arena. Before you start using rollers, consult a fitness professional for basic instruction. Once you feel comfortable with the exercises, this is an ideal tool to use at home.