Category: Date

Preventing Falls with Aquatic Exercises

One-third of the population over the age of 65 falls each year, and the risk increases proportionately with age. At 80 years, over half of seniors fall annually. Those who take a spill often develop a fear of falling. Fear gone unchecked may lead to limiting activities and loss of physical fitness, increasing risk of falling.

In these situations, it’s important to consider alternate interventions for the elderly — especially for those with joint pain and medical conditions that restrict land training. A recent study from University of California, San Francisco found that water exercises were more effective in improving balance than land exercises.
The buoyancy of the water helps patients stay upright and reduces their fear of falling. The water’s resistance allows patients more time to detect and correct postural errors that may lead to a fall. With aquatherapy, there is less chance for injury, and patients are able to push the limits with their balance, allowing for quicker carry over to functional, land-based activities.

The Endless Pool’s adjustable current offers a unique environment to challenge patients with speed, resistance and water depth, allowing them to advance to higher levels of stability and strength. Seniors are taught center of gravity control, postural strategies, gait exercises, strength, endurance and flexibility training.

Aquatherapy, with the Endless Pool, offers many benefits and should be seen as the modality of the future for fall prevention for the elderly.

Moon Physical Therapy, LLC
320 Ward Avenue, Suite 107; Honolulu, HI 96814
808-597-1005 | www.moonpt.com

One-third of the population over the age of 65 falls each year, and the risk increases proportionately with age. At 80 years, over half of seniors fall annually. Those who take a spill often develop a fear of falling. Fear gone unchecked may lead to limiting activities and loss of physical fitness, increasing risk of…
Are You ‘Good to Go?’
We all know death is a natural part of life and something we will all experience. But have you thought about how you want to be treated during your final days? How you would like to die?

Though it’s not an easy topic, and most of us avoid thinking about it, consider giving your death some thought this holiday season. What better way to start the New Year than with a resolution to complete your advance healthcare directive and talk to your family about what you want at the end of life?

In fact, there is a growing movement in Hawai‘I and the nation toward considering how we want to die and sharing those wishes with doctors, caregivers and loved ones. Increasingly, people feel everyone deserves to make their own personal decisions for dying with comfort, dignity and control.

Compassion & Choices Hawai‘i is part of this movement. They help people receive state-of-the-art care and the full range of options at the end of life, including disease-specific treatment, palliative care, hospice, avoidance of unwanted medical treatment and access to aid in dying, which is the option to advance the time of death if suffering becomes unbearable.

How do you get the conversation started?

After many attempts to engage family members, one Compassion & Choices client set her holiday table with advance directive forms at every place setting and announced, “Nobody gets dinner until these are filled out.” Now that’s some tough turkey!

And while the paperwork is important, the essential thing is to get the conversation going. Try starting with, “If one of us ever had to make decisions about your treatment because you couldn’t, it would be much easier if we knew what you really want.” Then ask the following:

Would you want life support if you have a terminal illness? What if you’re in a permanent coma? What if you have a chronic illness such as Alzheimer’s disease?

Do you always want to know the truth about your condition? About treatment options and their odds of success? And what does “success” mean to you and quality of life?

What will be important to you when you are dying? No pain? Hold on as long as possible? Family members present? What are your priorities?

Would you want to be in a nursing home if your condition warranted?

Compassion & Choices has a free Good-to-Go Toolkit to guide your conversation and document the results at www.CompassionAndChoices.org/advance-directive.

Compassion & Choices’ End-of-Life Consultation is a free service. Professional consultants listen to each unique situation and provide information, emotional support and patient advocacy as people navigate complex choices about terminal illness or the dying process.

For more information, free consultation, access to the Good-to-Go Toolkit and much more, call 1-800-247-7421 or visit www.CompassionAndChoices.org/hawaii.
We all know death is a natural part of life and something we will all experience. But have you thought about how you want to be treated during your final days? How you would like to die? Though it’s not an easy topic, and most of us avoid thinking about it, consider giving your death…
8 Things on My Medicare To-Do List

Planning ahead for 2014, made me stop and ponder for a moment … what are the things that are really important to me? First thing that came to my mind was my family. Second was the health of my family and myself. This article is dedicated to Medicare recipients and their caregivers so that we can all have a healthy and happy New Year. Here are 8 easy things that can help you navigate the healthcare maze.

1] Make an appointment for your Annual Wellness Visit. This is a Medicare benefit that provides you and your physician an opportunity to sit down and develop or update a personalized prevention plan to protect you against disease and disability, based on your health and risk factors. This is not an annual physical exam.

2] Follow that prevention plan!

3] Sit down with your loved ones and discuss your end-of-life wishes and complete an advanced health care directive form. Your medical team and family will use this document if you are ever unable to make your wishes known. Forms are available online at www.kokuamau.org and www.hawaiiship.org, or by calling the Sage PLUS Program at 1-888-875-9229.

The advanced health care directive can be as detailed as you like. Be sure to discuss it with your family and give a copy to your physician. If you currently have an advanced healthcare directive, take a moment and make sure it is still in line with your wishes.

4] Do you have a POLST (Physicians Orders for Life Sustaining Treatment) document on file? Printed on bright pink paper, and signed by both a doctor and patient, POLST helps give seriously ill patients more control over their end-of-life care. For more information, pick up the upcoming Feb/March issue of Generations Magazine.

5] Medicare provides most preventive benefits with no co-pay. Take advantage of them to keep you on track toward good health.

6] Do you have family members that help you with your health insurance? Health and drug plans offer a “authorized representative” form that enables that person to obtain information about your health coverage and billing on your behalf.

7] VOLUNTEER! Volunteering is a great way to meet new people, help your community and keep you active. The Hawaii SHIP has several different volunteer opportunities.

8] Do you belong to a community group that would like an educational Medicare presentation? Call or email Hawaii SHIP to request a speaker.

The Hawaii SHIP (State Health Insurance Assistance Program) is a volunteer-based Medicare counseling program that is available statewide through a grant from the Centers for Medicare & Medicaid Services. For assistance, volunteer information or to request a Medicare speaker, contact us 1-888-875-9229 or help@hawaiiship.org.

Planning ahead for 2014, made me stop and ponder for a moment … what are the things that are really important to me? First thing that came to my mind was my family. Second was the health of my family and myself. This article is dedicated to Medicare recipients and their caregivers so that we…
Healthy Food Tips for Your Kidney

Are you aware of the caution about drinking cola drinks? According to a 2007 study, “carbonated beverage consumption has been linked with diabetes, hypertension and kidney stones, all risk factors for chronic kidney disease (CKD). Cola beverages, in particular, contain phosphoric acid and have been associated with urinary changes that promote kidney stones.”(1) Drinking two or more colas per day was associated with increased risk of CKD.

Researchers are also learning that the issue may be more pervasive than carbonated beverages. The National Kidney Foundation recently reported that people who “consume a diet that is high in phosphorus could be doing damage to their heart, with or without pre-existing kidney disease.” The foundation reports that some studies link high amounts of phosphorus from food with increased phosphorus in the body, ultimately leading to cardiovascular disease(2) and kidney problems.(3)

Phosphorus is a mineral that is found in the body and aids in making strong bones, among other things. However, if too much phosphorus is consumed damage can result. The most common form of phosphorus in foods is an additive called “phosphate,” which can even be found in so-called “all natural” or “organic” foods and beverages.

It has been estimated that the average American adult needs only 700mg of phosphorus per day but is consuming at least twice this amount.(4) Phosphate can be found in some prepared boxed and frozen foods, many sliced breads, cereals, meats, dairy products and flavored drinks, among other items. Moreover, this form of phosphorus is nearly 100 percent absorbed by the body, unlike plant-based phosphorus like whole grains, dried beans, nuts and seeds, of which only 30 to 50 percent is absorbed.

People can control the amount of phosphorus they consume by reading food labels. Keep an eye out for the letters “PHOS” as part of an added ingredient when shopping for foods and beverages. The National Kidney Foundation recommends that people eat fresh, unprocessed foods. Also consider enjoying water with a twist of lemon rather than that cola or other carbonated drinks.

National Kidney Foundation of Hawai‘i
808-589-5976 | jeff@kidneyhi.org
www.kidneyhi.org | www.kidney.org

1 Epidemiology. 2007 July; 18(4): 501–506.doi: 10.1097/EDE.0b013e3180646338
2 AKA Framingham Offspring Study
3 http://www.kidney.org/news/monthly/phosphorus.cfm?homestatic=PhosphorusInfographic?homeslider=Phosphorus
4 Food and Nutrition Board, Institute

Are you aware of the caution about drinking cola drinks? According to a 2007 study, “carbonated beverage consumption has been linked with diabetes, hypertension and kidney stones, all risk factors for chronic kidney disease (CKD). Cola beverages, in particular, contain phosphoric acid and have been associated with urinary changes that promote kidney stones.”(1) Drinking two…
Legal: Siblingship

siblingship [sib-ling-ship]
noun (November 9, 2013):
1. The state of being related or interrelated
2. A state of affairs existing between one of two or more individuals having one common parent.

You will not find this word in the dictionary — it is a new word as of November 9, 2013. It describes the unique, textured, dynamic relationship existing between siblings. Think about the uniqueness of this relationship. Siblings begin their relationship at a very young age. My twins, for example, literally started their lives together. And, if they are fortunate, they will experience their lives to old age together. They experience joys and setbacks together, laugh and cry together, and fight together. And through the fighting, they can learn conflict resolution together. No other relationship is quite like a “siblingship.” Parents are there at the beginning, but all too often they leave too early. Spouse’s join us in our adult lives. Friends often come and go.

When parents die, siblings are called home to “divide up the pie.” And what I experience all too often with the families that I work with, is that the siblings fight over the same things that they fought over when they were kids — property and fairness. However, the parents are no longer there to referee and help divide up the pie fairly.

The estate planning process, if done properly, can do much to minimize the risk of fighting when parents die. However, many plans do not speak clearly enough in this respect. Leaving a family home or a heirloom “equally to the children” does not go far enough to help avoid the family fight. To leave it up to grieving adult children to decide what is “equal” when it comes their inheritance, puts too much pressure on their relationship.

If the parents and the estate planning attorney do not spend enough time minimizing the risk of fighting between the siblings, we risk fracturing, or worse destroying this unique, wonderful relationship — the siblingship.

The estate plan ultimately is supposed to mirror and reflect our lives, and the relationships we built. If your plan does not mirror and reflect your most important values, or does not speak clearly enough to ensure that it helps to preserve the relationships between your children — their siblingship — I encourage you to review your plan with your estate planning attorney.

Stephen B. Yim, Attorney at Law
2054 S. Beretania St., Hon.
(808) 524-0251
stephenyimestateplanning.com

siblingship [sib-ling-ship] noun (November 9, 2013): 1. The state of being related or interrelated 2. A state of affairs existing between one of two or more individuals having one common parent. You will not find this word in the dictionary — it is a new word as of November 9, 2013. It describes the unique,…
Frank, as Always: Big-Band Musical Baggage

When Generations invited me to write an article about my high school days, one of the first memories that came to mind was of riding in the backseat of my dad’s 1959 Chevy Impala every morning, heading to school and listening to his favorite radio program.

In the 50s, there was this DJ named Hal Lewis (aka J. Akuhead Pupule) but I really wasn’t “tuned in” to his show, however, he amused my dad and constantly made him laugh out loud. Aku broadcasted from the “Tree House” at the International Market Place in the early 1960s and played big-band music and stand up singers like Frank Sinatra, Vic Damone, Dean Martin, The Lennon Sisters, The McGuire Sisters, etc. I’ve come to realize now that what I listened to back then affected me for the rest of my life. (Keep that in mind … your kid is being shaped while sitting in the back seat of your car. I have people come up to me and say they listen to my radio show now because their mom and dad used to listen to me in the morning, too.)

When not with dad, I would listen to this other guy named Elvis Presley on KPOI. So the music that came from dad’s radio each morning was something I had to endure. And to see my dad moving his shoulders to the music, it was kinda goofy! But oddly enough, sitting back there all those years, I started to appreciate the big-band sound and recognize the songs and the people who sang them — Tony Bennett and Nat King Cole. But I had no idea as to the weight of this music and what it meant to my father’s generation — The Greatest Generation.

It wasn’t until much later that I realized I was a product of the generation who grew up in the U.S. during the deprivation of the Great Depression, and then went on to fight in World War II. I’m a WWII baby. A baby boomer!

The Greatest Generation dealt with segregation, detention, internment, prejudice and so much more. Yet, many national figures and heroes came out of those trying times. Martin Luther King, for example, came from the Greatest Generation and he spoke eloquently from the depths of disparity, rising up and changing our country and the world forever. And the 442nd Regimental Combat Team and 100th Infantry Battalion local boys who gave more than most … these men were not going to let anything get in their way in achieving their best.

The Greatest Generation went for it!

And when I think back on riding in my dad’s car, I feel like I was on the end of a very long shooting star, streaking across the midnight sky. I really had no idea what my parents had gone through but I knew that everything was changing.

All I’m saying is we must always holomua, keep moving and look forward, but never forget what was laid down before us.

Join the conversation with Frank B. Shaner on Facebook and experience his art online at www.frankbshaner.com.

“The Greatest Generation” … Go for Broke!
Oil on canvas, 24” x 18”

When Generations invited me to write an article about my high school days, one of the first memories that came to mind was of riding in the backseat of my dad’s 1959 Chevy Impala every morning, heading to school and listening to his favorite radio program. In the 50s, there was this DJ named Hal…
Important Notice: Your Medicare Plan Not Offered in 2014?

Every year, a few weeks before Halloween, I get dozens of calls from Medicare beneficiaries with questions about Medicare’s Annual Enrollment Period, which begins October 15 and ends December 7. It is the time when Medicare beneficiaries can decide to keep their existing health plan or select a new plan that becomes effective January 1 of the following year. I provide tips to help callers review their options. This year, in addition to those calls, my voicemail overflowed with seniors who received an unexpected letter from about their Medicare health coverage. The notice explained that their Medicare plan would not be offered in 2014 and was ending December 31, 2013. As a result, they would need to take action and select a new plan by December 31, 2013, or their coverage would revert to Original Medicare only.

SO HERE ARE MY TOP FIVE TIPS:

Tip 1: You qualify for a special enrollment period from October 15 to February 28, 2013. So now is the time to consider your options. If you don’t take action by December 31, you’ll have Original Medicare coverage only, and will lose prescription drug coverage unless you join a separate Medicare prescription drug plan.

Tip 2: Decide to join another Medicare Advantage health plan because your plan has notified you that your existing plan will no longer be offered. If you wait until after February 28 to join a new plan with prescription drug coverage, you may have to pay a late-enrollment penalty.

Tip 3: Call Medicare 24 hours, 7 days a week at 1-800-MEDICARE for help.

Tip 4: Refer to the 2014 Medicare & You Handbook for detailed information.

Tip 5: For help comparing plans: Call Hawai‘i’s State Health Insurance Assistance Program, Sage PLUS at 1-888-875-9229. All counseling is free.

Martha Khlopin hosts the popular weekly radio program “Medicare Moment with Martha — The World of Medicare” sponsored by AlohaCare. It airs on KHNR-690AM on Saturdays from 11–11:30 a.m. and on KGU-99.5FM on Sundays from 10–10:30 a.m. For info, call (808) 973-0754, mkhlopin@alohacare.org.

Every year, a few weeks before Halloween, I get dozens of calls from Medicare beneficiaries with questions about Medicare’s Annual Enrollment Period, which begins October 15 and ends December 7. It is the time when Medicare beneficiaries can decide to keep their existing health plan or select a new plan that becomes effective January 1…
Solar Savvy: Tips from the Industry Pros
Look around. Gleaming new solar panels are going up on roofs all over Hawai‘i. It’s no wonder — with our exorbitant electricity rates, year-round sun and substantial tax credits, installing a PV system in Hawai‘i makes so much sense, especially if you’re on a fixed income. Homeowners who educate themselves before investing will enjoy reliable energy savings for generations to come.

Here are four tips from the pros:

Be aware of sales gimmicks like cash rebates or free trips. Because of the tax credits involved, the government frowns upon these kinds of incentives. Avoid being vulnerable to an audit.

Insist on a reputable solar panel manufacturer. There are literally dozens of new brands jumping on the PV bandwagon. You are making an investment that should last decades. Will the company be around to honor its warranty?

Ask if the provider employs its installers. Many providers use sub-contractors to handle the all-important installation aspects. If something goes wrong two years down the road, you don’t want your provider passing the buck.

Be sure to hire a full-service, licensed solar company. Look for the state’s C-60 Solar Power Systems Contractor license. This ensures your provider has passed rigorous testing and has the necessary experience with solar, roof work, hookups and permitting to do a top-notch job.

Alternate Energy
803 Ahua St., Honolulu, HI 96819
808-842-5853 | www.AlternateEnergyHawaii.com
Look around. Gleaming new solar panels are going up on roofs all over Hawai‘i. It’s no wonder — with our exorbitant electricity rates, year-round sun and substantial tax credits, installing a PV system in Hawai‘i makes so much sense, especially if you’re on a fixed income. Homeowners who educate themselves before investing will enjoy reliable…
Medicare: Making the Most of Your Health & Drug Plan

Congratulations! You have made your decision of the Medicare Health and Drug Plan for 2013. For many, this might mean that you stayed with the plan that you had in 2012 and for some, you may have looked at the options available in your area and have enrolled with a new Medicare plan. The decision that you made is for the calendar year 2013: so let’s look at some ways that you can use the plan to your “advantage”— after all, they are called Medicare Advantage Health Plans.

When you receive your health or drug plan packet that includes the evidence of coverage and other important information, make sure you and your caregiver take a moment to look at what the plan covers and how to access those services. Also, if you would like someone else to be able to ask questions of your plan on your behalf, take a moment and fill out the “authorized representative” form. This is always better done sooner rather than later.

First, what should we NOT do? We should not assume that your neighbor, friend or family member has the same plan as you and ask them what providers to use. Plans have different rules and different providers. A health maintenance organization (HMO) works very different from a preferred provider organization (PPO). We have seen many a Medicare member be responsible for a medical bill because they went outside the allowable network.

What should we do? Understanding what type of plan you have enrolled in is the first step; we have several different types of plans in Hawai‘i including HMOs (you must use the plan’s network or their contracted providers) PPOs (you can use both preferred providers (and pay less money out of pocket), PFFS (works with any provider who accepts the plan and agrees to treat you) and SNP (special needs plans that are available for those with Medicare and Medicaid), who are the providers and how can you save the most money.

Still have questions, first call your health or drug plan (remember when possible it is best to call later in the afternoon in Hawai‘i and you will have less of a wait time), they are best able to answer the questions about your specific coverage. You can always find the phone number on your membership card.

Are you new to Medicare in 2013? Join us on our “Welcome to Medicare” webinars that are held in February/April/June/August. To sign up for one, go to www.hawaiiship.org and look for the webinar box. Certified SHIP volunteers are also available to help you navigate the Medicare system. We can be reached at 1-888-875-9229. The Hawai‘i SHIP receives a federal grant from the Centers for Medicare & Medicaid Services to provide information and assistance to you regarding your Medicare benefits. The program is located under the Department of Health’s Executive Office on Aging.

Congratulations! You have made your decision of the Medicare Health and Drug Plan for 2013. For many, this might mean that you stayed with the plan that you had in 2012 and for some, you may have looked at the options available in your area and have enrolled with a new Medicare plan. The decision…
Welcome to the Generations808.com Homepage

Main navigation menu: Use these topics to navigate to the various pages in our site. As you run the cursor over the word, it’ll become bold. These topics will always exist on every page. Throughout the homepage, there are also various other buttons that’ll take you to any one of these topics.

Home is the main page.

This Issue will take you to the current issue’s table of contents with live\ links to individual articles.

Resources will take you to resource guide archives.

AIP Videos show a list of the Aging In Place Workshop speakers.

Events: contains the events calendar.

Advertising contains all of our advertising and marketing information.

About Us is just a little background.

Contact Us via mail, phone or email.

Subscribe provides a subscription form so you can enjoy Generations Magazine delivered to your door every other month.

Main navigation menu: Use these topics to navigate to the various pages in our site. As you run the cursor over the word, it’ll become bold. These topics will always exist on every page. Throughout the homepage, there are also various other buttons that’ll take you to any one of these topics. Home is the…
UH Press Presents: IF IT SWINGS, IT’S MUSIC: THE AUTOBIOGRAPHY OF HAWAI’I’S GABE BALTAZAR, JR.

Hawai‘i’s legendary jazz musician Gabe Baltazar, Jr. has thrilled audiences since the late 1940s with his powerful and passionate playing. In his memoir, If It Swings, It’s Music, Gabe takes readers along the long road to becoming one of the very few Asian Americans who has achieved worldwide acclaim as a jazz artist.

Born in Hilo and raised in Kalihi-Palama, Gabe (Gabriel Ruiz Hiroshi Baltazar Jr.) was encouraged by his father, an accomplished musician, to take up the clarinet and saxophone. As a teenager during World War II, Gabe performed with the Royal Hawaiian Band but spent his weekends playing in swing bands. After establishing himself in the West Coast jazz scene, in 1960 he rose to prominence as lead alto saxophonist of the famed Stan Kenton Orchestra. The group recorded more than a dozen albums and won two Grammy Awards.

From 1964 to 1969, Gabe recorded with Dizzy Gillespie, James Moody, Oliver Nelson. He was also a regular in the Los Angeles recording studios, and he filmed with Pat Boone, Phyllis Diller and Glen Campbell. In 1969, Gabe returned to Hawai‘i to work as assistant director for the City and County of Honolulu’s Royal Hawaiian Band, a post he held until 1985. He brought jazz to the public schools and went on to become Hawai‘i’s premier jazz artists. Now 84, he mainly performs informal gigs with friends and family.

Gabe’s memorable encounters with the greatest names in jazz is fond record of days past. (University of Hawai‘i Press, paperback, $24.99)

Hawai‘i’s legendary jazz musician Gabe Baltazar, Jr. has thrilled audiences since the late 1940s with his powerful and passionate playing. In his memoir, If It Swings, It’s Music, Gabe takes readers along the long road to becoming one of the very few Asian Americans who has achieved worldwide acclaim as a jazz artist. Born in…
Hawaii Connector Must Be Consumer Friendly, Accountable and Sustainable
Beginning in January 2014, Hawai‘i residents who are without health insurance, small businesses, and those who are self-employed will be able to be covered by insurance purchased through an online marketplace known as the Hawaii Health Connector. The Connector was established by the state Legislature in 2011 to offer health plans to the public under the Affordable Care Act.

After more than $200 million in federal dollars, the Hawaii Connector was last in the nation to provide plan information. It has a long way to go to become the reliable and consumer-friendly organization that Hawai‘i deserves. Equally important, it must be able to sustain operations without federal funds in 2015 — just 14 months away.

AARP wants the Connector to succeed, but as of the beginning of November its website was minimally functional. Navigation is cumbersome and tools consumers need are lacking. To be consumer friendly, the website needs to add major features such as:

tools to assist in understanding plan choices

quality of care information, including quality ratings for hospitals, physicians and other providers

patient experience information that allows patients to rate their providers

complaint data

Accountability and transparency are major concerns. The Connector was created by the Legislature as the only private, non-profit exchange in the nation. It allowed HMSA, Kaiser, and Hawaii Dental Service to have voting board members despite clear conflicts of interest. The concept was championed by Sen. Roz Baker of Maui. Arguments were that a private entity, freed of the restraints of government bureaucracy, would be more nimble and cost effective.

But as a private entity, the Connector is not subject to the State Sunshine Law. In an attempt to remedy this lack of openness, Sen. Les Ihara introduced SB 830 that would have required the Connector to comply with open meeting and notice provisions. The bill was held in the Consumer Protection Committee, chaired by Sen. Baker, and it never saw the light of day.

During the informational briefing to the Legislature on October 9, there were lots of outreach anecdotes. Consumer outreach and education is critical. The Connector Board should take the lead on a specific outreach plan to reach Hawai‘i’s 100,000 uninsured residents.

The deadline for all exchanges in the nation to be self-sustaining is rapidly approaching. Sustainability is a federal mandate and the Connector needs to deal with it quickly. An early Connector estimate put its 2015 operating costs at nearly $16 million. It needs to identify revenue to match. The Connector Board needs to provide the direction and pull out all stops to become sustainable. There must not be any last-minute surprises. The Connector has to come through. After a huge investment in federal tax dollars, Hawai‘i’s taxpayers must not be asked to pay the difference in 2015 and beyond or — worse yet — bailout the Connector by making it a state agency.
Beginning in January 2014, Hawai‘i residents who are without health insurance, small businesses, and those who are self-employed will be able to be covered by insurance purchased through an online marketplace known as the Hawaii Health Connector. The Connector was established by the state Legislature in 2011 to offer health plans to the public under…

Category: Date

How do you get the conversation started?

SO HERE ARE MY TOP FIVE TIPS:

Here are four tips from the pros: