Month: October 2015

Breast Cancer Treatment

Posted on by Michelle Fritsch, Pharm.D.

697px-Pink_ribbon.svgIt is Breast Cancer Awareness Month. We are seeing pink in all directions.

Breast cancer is the most common type of cancer in women (with the possible exception of some skin cancers).

One in eight women will be diagnosed with invasive breast cancer.

Ductal carcinoma in situ is a type of breast cancer that is contained in the duct, so it is not an invasive breast cancer. Another 60,000 women will be diagnosed with this during the year.

The risk of breast cancer increases with age and seems to peak in the 70’s.

All women at all ages should get regular mammograms. These can find the cancer early. Most guidelines recommend every year starting at age 40. This screening should continue for as long as a woman is still loving and living life! You might have heard on the news this week the American Cancer Society has changed its guidelines for annual mammograms. For woman at average risk for breast cancer, these new guidelines are to start at age 45 and go to every other year at age 55. Note, for women at high risk, screening starts earlier and remains yearly.

When a diagnosis is made, find a breast cancer center who can support you through each decision and each phase that follows. You want to be surrounded by a team of caring professionals who are patient and explain everything until you fully understand.

Surgery, radiation, chemotherapy, and medications are often parts of the treatment options. Different combinations of these treatments will be used based on the important specifics of your cancer and your preferences.

When breast cancer is estrogen-responsive, the following medications are often part of the treatment regimen.

Tamoxifen is often used after diagnosis and initial treatment. It can also be used to lower breast cancer risk in high risk women. It is an antiestrogen medication, so it decreases the impact of estrogen that often drives the changes that lead to breast cancer. The typical length of treatment has been five years. There is new data that it should be taken for 10 years in some women with breast cancer. Be sure to discuss this with that great team of providers you have to see how long you should take it. The main side effects are hot flashes and changes in your menses if you are premenopausal. Tamoxifen can also cause fatigue and increase your risk of clotting.

Aromatase inhibitors are another class of medication sometimes used as part of the treatment for breast cancer or to prevent breast cancer in high risk women. There are three medicines currently in this class. They are anastrazole (brand Arimidex), exemestant (brand Aromasin), and letrozole (brand Femara). These medications decrease the available estrogens by stopping the conversion of androgens to estrogens. These medications can increase your cholesterol and decrease your bone density (increase your risk for osteoporosis). They can also cause hot flashes and fatigue.

Some women take one of the above medications. Others take one type for a period of time then switch to the other. Which type of medication and for how long is an important decision made with your healthcare providers. The decision is based on some tests about your specific type of cancer, its responsiveness to estrogen, any other medical conditions you have, and your preferences.

I highly encourage you to discuss the benefits of the medications and any risks, including side effects, with your cancer treatment team. Your pharmacist is another source of detailed information about these and other medicines.

For more information about breast cancer treatment medications, contact us at www.medsmash.com.

If you want to get more involved in the search for a cure, I encourage you to read about the Army of Women organized by Dr. Susan Love. This program has made millions of volunteer women sources of new data in the search for a cure. I have participated in a couple of studies. It takes little time. One study collected only information. The other did a bone scan. No tests or procedures or data will be taken from you without your full consent. You can made a difference!

Biblical Application

Diagnoses such as breast cancer can invoke many feelings. One of those can be a fear of loss. Even before diagnoses are finalized, options are considered, prognoses are made, our minds can take us down paths of fear, anxiety, depression, hopelessness, futility, or impending doom.

God is aware of our needs and our weaknesses. He knows how our mind works when faced with a diagnosis like this.

The Bible is full of verses of hope and assurance. You truly can lean on God in all situations, no matter how frightening they may seem.

Isaiah 41:10 ESV

Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.

Philippians 4:6-7 ESV

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

Psalm 56:3 ESV

When I am afraid, I put my trust in you.

2 Timothy 1:7 ESV

For God gave us a spirit not of fear but of power and love and self-control.

Deuteronomy 31:6 ESV

Be strong and courageous. Do not fear or be in dread of them, for it is the Lord your God who goes with you. He will not leave you or forsake you.”

Claim and cling to this hope, love, and assurance that is yours in Christ. You are never alone. You are never abandoned. You are eternally loved.

I encourage you to share this hope beyond understanding with anyone you know facing breast cancer. You can be a light in their dark time, especially if they have not experienced the power of your God.

“Again and again, I’ve found Him faithful to respond and the closer I move to Him, the safer I feel and the better I rest.”

Patsy Clairmont

Blessings,

Michelle

Image thanks to MesserWoland – own work created in Inkscape, based on the graphics by Niki K

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Medications to avoid when over age 65

Posted on by Michelle Fritsch, Pharm.D.

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Since 1991 there has been a group of geriatricians and other physicians identifying medicines that might be inappropriate in people over age 65. Dr. Mark Beers originally led this group, so it is called the ‘Beers Criteria’. This list has been updated every few years. The most recent update was this month.

The medications on this list have SAFER and/or MORE EFFECTIVE options available.

Some of the reasons for medications to make the list include:

  • blood pressure lowering medicines that cause more dizziness and falls than other options
  • medicines with anticholinergic (very drying) effects that can have several negative effects including worsening memory
  • anxiety medicines that cause thinking/memory problems and falls
  • depression medicines that cause several problems
  • allergy medicines that cause drowsiness, driving accidents, and falls
  • medicines that are cleared from the body through the kidneys which slow down with age
  • medicines that are cleared from the body through the liver which can slow down with age
  • medicines that are ok at low doses but dangerous at high doses
  • medicines that can cause delirium
  • medicines that can worsen memory
  • medicines that can cause constipation
  • medicines that can make urination with prostate enlargement even more difficult

This year, for the first time, guidelines for safer options to replace these dangerous medicines were written. This is exciting news!

If you are over 65, please talk with your prescribers about these lists of potentially inappropriate medicines and these lists of safe alternatives.

For a personal evaluation of your medicines, please contact www.medsmash.com.

Biblical Application

In your daily walk with God, what are the most effective steps and activities? What does the Bible say you should do regularly?

And, where are the pitfalls? What should you avoid?

Just as the Beers List guides prescribers to select the most beneficial and safest medicines, the Bible guides our spiritual practices. Your heart, your tongue, your thoughts, your study, your time, and your actions are included in this guidance.

Romans 12:2 ESV

Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect.

Colossians 3:5-10 ESV

Put to death therefore what is earthly in you: sexual immorality, impurity, passion, evil desire, and covetousness, which is idolatry. On account of these the wrath of God is coming. In these you too once walked, when you were living in them. But now you must put them all away: anger, wrath, malice, slander, and obscene talk from your mouth. Do not lie to one another, seeing that you have put off the old self with its practices and have put on the new self, which is being renewed in knowledge after the image of its creator.

James 1:19-20 ESV

Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God.

Ephesians 4:32 ESV

Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you.

James 1:22-27 ESV

But be doers of the word, and not hearers only, deceiving yourselves. For if anyone is a hearer of the word and not a doer, he is like a man who looks intently at his natural face in a mirror. For he looks at himself and goes away and at once forgets what he was like. But the one who looks into the perfect law, the law of liberty, and perseveres, being no hearer who forgets but a doer who acts, he will be blessed in his doing. If anyone thinks he is religious and does not bridle his tongue but deceives his heart, this person’s religion is worthless. Religion that is pure and undefiled before God, the Father, is this: to visit orphans and widows in their affliction, and to keep oneself unstained from the world.

There are certainly many more verses that guide our lives. These can be a start in developing a strategy to avoid inappropriate, dangerous behaviors and replace them with life-giving, holy options.

Blessings,

Michelle

Triggers – Asthma and COPD

Posted on by Michelle Fritsch, Pharm.D.

inhaler imageThere are so many things that can bring on an asthma attack making it hard to breath. Some examples are:

  • Perfume
  • Smoke
  • Dust
  • Weeds
  • Pollen
  • Foods
  • Pets
  • Exercise
  • Cool, damp air

People with asthma can go from feeling fine to struggling for breath in just a few minutes.

The same thing can happen to some people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis). Not all people with COPD have an asthma-like component, but some do.

There are medications that can help PREVENT these sudden attacks.   There are also medications that can reopen the airways to TREAT these attacks.

The medications used most often are given by inhalers. This allows the medication to go to the lungs where it is needed without having such a big impact on the rest of the body. This cuts down on side effects.

If you are prescribed inhalers, it is important to take them regularly and as prescribed, especially the ones taken one to times per day.   They are intended to PREVENT these attacks. They will not be helpful if only taken once in awhile during attacks. They need to be taken every single day.

The ones you take as needed should be taken with careful technique. They won’t work if they aren’t used properly. This is harder than it sounds. Be sure your doctor or your pharmacist has shown you step by step how to use your inhalers. Then, show them how you use them to be sure your technique is correct.

One more thing, be sure to always rinse out your mouth and spit out the water after using a steroid inhaler. These inhalers are very effective at preventing attacks, but they can also make it easy to get an infection in your mouth that is painful. Rinsing your mouth after EACH use cuts way down on the risk of this mouth infection.

Inhalers save lives. But they must be taken at the right times and with the right technique.

For more information, contact us at www.medsmash.com.

BIBLICAL APPLICATION

Not only are there triggers for asthma attacks, we often have triggers that get us off track on our day and in our spiritual walk. These can be things that distract us, things that confuse us, and often things that make us angry.

What are those topics that you feel so strongly about you just have to chime in to conversations about them? Maybe you can ignore some things and let them slide on by. But, what are the things that you just have to participate in the discussion?

What are the things that make you really angry? What are your hot button triggers that send you into a rage?

We all have them. It’s the way we are ‘wired’. Just as there are medications that can prevent the sudden reaction to asthma triggers, there are steps we can take to reduce our reaction to our life triggers.

First, throughout the Bible we are reminded that anger should be contained.

Ephesians 4:26-27

Be angry and do not sin; do not let the sun go down on your anger, and give no opportunity to the devil.

James 1:19-20 ESV

Know this, my beloved brothers: let every person be quick to hear, slow to speak, slow to anger; for the anger of man does not produce the righteousness of God.

Proverbs 29:11 ESV

A fool gives full vent to his spirit, but a wise man quietly holds it back.

Proverbs 19:11 ESV

Good sense makes one slow to anger, and it is his glory to overlook an offense.

Proverbs 15:1 ESV

A soft answer turns away wrath, but a harsh word stirs up anger.

Proverbs 15:18 ESV

A hot-tempered man stirs up strife, but he who is slow to anger quiets contention.

There are at least 60 verses in the Bible dealing with anger management. James sums up the instruction well:

James 4:1-2 NIV

What causes fights and quarrels among you? Don’t they come from your desires that battle within you?  You want something but don’t get it. You kill and covet, but you cannot have what you want. You quarrel and fight. You do not have, because you do not ask God.

Take time to consider and identify your triggers. Again, we all have them. Then, take them to God to help you avoid them or handle them with grace rather than anger.

Blessings,

Michelle

Image credit: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services

Getting Better – It Takes More than a Prescription

Posted on by Michelle Fritsch, Pharm.D.

ID-10093880Do you have a health issue? If so, you just need a prescription, and you’ll be all better, right?

Huey Lewis sang that he ‘wanted a new drug’. His proposed ‘new drug’ had no side effects and made him feel like he felt when falling in love.

Does that describe the prescriptions that you take?

Unfortunately it’s just not that easy.

All medications have side effects. Many medications have very specific instructions to use them in a way that leads to the best possible outcome.

But, we are all busy. Who has time for those pesky details? Does it REALLY matter if you take it with food or first thing in the morning when you brush your teeth? If you take two when you remember them vs one in the morning and one at night, that’s ok, right? Do you really have to breathe in some special way when you use an inhaler? You just squirt it in, right?

To get the most benefit from your medications – and – to minimize your side effects, these details are very important. Let’s explore some of the types of important details.

Timing – If your medication is to be taken more than one time per day that means it doesn’t last a full 24 hours. To keep the medication active in your body, you need to take it more than once. If you take it too close together, you will get more than a full dose while the two doses overlap. This can increase your side effects or even be dangerous because you have too much medication. If you miss a dose, you will have time with little or no medication in your system to treat your condition.

Food – Some medications will bind to medication in the stomach and not be absorbed. So, you will get no medication in your body if you take it with food. Other medications will make you sick to your stomach if you don’t take them with food. Food will decrease or prevent that side effect of feeling nauseous.

Finishing early – Some conditions require that the whole bottle/set of medications be taken. Often we think once we feel better we’ll just stop taking the medication. Sometimes we even keep the extra in case we need them another time. Some medications, like antibiotics, need to be taken until all are gone. You start feeling better when the bacteria is made weak, but it is not gone yet. If you stop the antibiotic when you feel better, the bacteria can get strong again. Often that same antibiotic won’t weaken the bacteria the next time, so you will need to be on an even stronger antibiotic.

Finishing too quickly – Other medications need to be gradually taken away rather than stopped all at once. Your body can’t take back over all at once if you have been taking these medications. Examples are beta blockers for high blood pressure and prednisone for inflammatory reactions. The gradual taper of these medications is essential to avoid severe side effects. (Note, this DOES NOT mean you are addicted.)

Technique – Inhalers, eye drops, ear drops, injections, patches, suppositories, and other medication forms can be difficult to use correctly. If you don’t use them just right, you won’t get the full benefit of the medication. This is a waste of money, and more importantly, won’t help you feel better. For some of these medications, correct use can even be the difference between getting better and calling 911.

So, I highly encourage you to pay attention to these details about your medications. If you see instructions you don’t understand or know their purpose, ask your pharmacist. Pharmacists are there to explain, demonstrate, and help you get the most from your medications.

For more information, contact us at www.medsmash.com

BIBLICAL APPLICATION

What are the quick fixes to Heaven? What is the way to assure entry then get on with the busy-ness of life?

First, God’s every desire for you to live eternally in Heaven is clear in the Bible. The basics of the path to God are below.

John 3:16 ESV

“For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life.

John 14:6 ESV

Jesus said to him, “I am the way, and the truth, and the life. No one comes to the Father except through me.

Ephesians 2:8-9 ESV

For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast.

Once you have had the amazing experience of finding God, and you have welcomed Him in to your life, what next?

Do you then work hard to earn God’s love? No, God loves you no matter what. His grace covers anything you do or do not do.

Do you then go on about your business now that this task is done?

Timing – Filling your life with God is an all-of-the-time, every day, all times of day opportunity. I don’t think any of us take advantage of this fully. Not a single one of us is perfect. But, God’s grace is always there for you!

Food – The Bible, the word of God, is your nourishment. This is not a one-time read that then goes on the shelf. Each time you read it, you will learn new things. God has so much to share with you!

Finishing early – It can be tempting to make this life-altering, life-filling decision to dedicate yourself to God. It can then be easy to move on to other things. God wants to be in close contact with you all of the time, good times and bad, busy times and leisure. I highly encourage you to experience this close daily walk with your God!

Jesus states there are two main rules for life for us.

Mark 12:30-31 ESV

And you shall love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength.’  The second is this: ‘You shall love your neighbor as yourself.’ There is no other commandment greater than these.”

This prescription to walk with God is a daily, sometimes even minute-to-minute, dose that is always available. And the side effects are wonderful!

Blessings,

Michelle

Image courtesy of rakratchada torsap at FreeDigitalPhotos.net